What is the clinical evidence from this study?

Population: Myocardial scar (n=8). Intervention: Pulsed field ablation (PFA) vs. Ungated PFA applications. Primary outcome: Sustained ventricular arrhythmias requiring defibrillation.

What question did this study set out to answer?

To evaluate the efficacy of pulsed field ablation in penetrating ventricular scar tissue, assess arrhythmia risks, and determine the protective impact of QRS gating.

January 1, 2023Circulation Arrhythmia and ElectrophysiologyOpen Access

Electrophysiology, Pathology, and Imaging of Pulsed Field Ablation of Scarred and Healthy Ventricles in Swine

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Key result

QRS-gated ventricular PFA penetrates scar and reduces sustained arrhythmias to 0% versus ungated delivery.

Why the study?

Although pulsed field ablation can penetrate ischemic scar, details regarding its efficacy, risk of arrhythmias, and imaging insights are lacking.

Does QRS-gated pulsed field ablation safely penetrate ventricular scar without inducing arrhythmias in a porcine model?

Key Points

To evaluate the efficacy of pulsed field ablation in penetrating ventricular scar tissue, assess arrhythmia risks, and determine the protective impact of QRS gating.
Studied 8 swine, including 5 with coronary occlusion infarct scars, 1 with radiofrequency ablation scar, and 2 healthy controls.
Delivered bipolar, biphasic 2.0 kV pulsed field ablation lesions guided by electroanatomical mapping, fluoroscopy, and intracardiac echocardiography, followed by cardiac MRI 2 to 7 days post-ablation.
Pulsed field ablation penetrated both infarct and iatrogenic radiofrequency ablation scar tissue across all examined sections.
Sustained ventricular arrhythmias requiring defibrillation occurred in 4 of 187 (2.1%) ungated pulse applications compared to 0 of 64 (0%) QRS-gated applications.
Dark-blood late-gadolinium-enhanced MRI sequences improved the detection of endocardial borders and lesion boundaries relative to conventional bright-blood sequences.

Structured PICO

Does QRS-gated pulsed field ablation safely penetrate ventricular scar without inducing arrhythmias in a porcine model?

Population

8 swine (5 with coronary occlusion infarct scar, 1 with radiofrequency ablation iatrogenic scar, 2 healthy controls)

Intervention

Bipolar, biphasic pulsed field ablation (PFA) (2.0 kV) using an 8 Fr focal catheter, delivered over scarred and healthy myocardium

Comparator

Ungated vs QRS-gated PFA applications

Outcome

Ability of ventricular PFA to penetrate scarred tissue, induction of ventricular arrhythmias, and MRI assessment of lesionssurrogate

Main Result

Absolute Event Rate: 0% vs 2.1%

In a porcine model, pulsed field ablation successfully penetrates ventricular scar tissue, and QRS-gated delivery eliminates the risk of PFA-induced ventricular arrhythmias.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Hypothesis-generating for QRS-gated PFA in ventricular scar; prospective human studies needed before clinical adoption.

Cite This Study

Kawamura et al. (2023) studied Myocardial scar (n=8). Pulsed field ablation (PFA) vs. Ungated PFA applications was evaluated on Sustained ventricular arrhythmias requiring defibrillation. Ventricular pulsed field ablation successfully penetrated myocardial scar, and QRS-gated delivery eliminated sustained ventricular arrhythmias compared to ungated applications (0% vs 2.1%).

synapsesocial.com/papers/6a0f6a582badbc352afe23de https://doi.org/10.1161/circep.122.011369

Topics

Ventricular arrhythmias AF ablation outcomes

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Electrophysiology, Pathology, and Imaging of Pulsed Field Ablation of Scarred and Healthy Ventricles in Swine

Key Points

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

Electrophysiology, Pathology, and Imaging of Pulsed Field Ablation of Scarred and Healthy Ventricles in Swine

Key Points

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider