Direct current irreversible electroporation successfully created permanent lesions in the epicardial ganglionic plexus at 95.2% of targeted sites with minimal collateral myocardial damage.
Does direct current irreversible electroporation safely and effectively ablate epicardial ganglionic plexi without collateral myocardial damage in a canine model?
Direct current irreversible electroporation provides a safe and tissue-selective method for epicardial ganglionic plexus ablation with minimal collateral myocardial damage in a canine model.
BACKGROUND: Endocardial radiofrequency ablation of epicardial ganglionic plexus (GP) for atrial fibrillation (AF) is complicated by myocardial damage. OBJECTIVES: We hypothesized that an epicardial approach with a novel nitinol catheter system capable of causing irreversible electroporation (IRE) with direct current (DC) could selectively and permanently destroy GP without collateral myocardial injury. METHODS: Acute studies and medium-term terminal studies (mean survival, 1137 days) were performed with seven dogs. In the acute studies, DC was used to target epicardial GP within the transverse sinus, oblique sinus, vein of Marshall, and right periaortic space. Successful electroporation was defined as the presence of ablative lesions in the GP without collateral myocardial damage. A four-point integer system was used to classify histologic changes in tissue harvested from the ablation sites. Atrial effective refractory period (AERP) was measured during the acute and medium-term studies. RESULTS: For six dogs in the medium-term studies, the postablation period was uneventful without complications. Lesions were successfully created at 20 of 21 sites (95.2%) with more than minimal myocardial damage in one dog. An increase in AERP occurred in both atria during the acute studies but was maintained only in the right atrium at medium-term follow-up (5032 milliseconds). No dog had damage to the esophagus, adjacent great arteries, or pulmonary veins. CONCLUSIONS: This proof-of-concept study suggests that safe, effective, and selective epicardial ablation of GP can be performed with DC by IRE with minimal collateral myocardial damage.
Padmanabhan et al. (Fri,) conducted a other in Atrial fibrillation (n=7). Direct current irreversible electroporation vs. Control sites was evaluated on Successful creation of ablative lesions in the ganglionic plexus without collateral myocardial damage. Direct current irreversible electroporation successfully created permanent lesions in the epicardial ganglionic plexus at 95.2% of targeted sites with minimal collateral myocardial damage.