Key result
PEF ablation of epicardial ganglionated plexi increases AERP ~19% in canines without myocardial injury.
Why the study?
Ablation of ganglionated plexi for AF shows promise, but thermal energy sources pose risks of collateral tissue injury.
Does pulsed electric field ablation of epicardial ganglionated plexi alter markers of cardiac autonomic tone safely in acute canine models?
Does pulsed electric field ablation of epicardial ganglionated plexi alter markers of cardiac autonomic tone safely in acute canine models?
Effect estimate: 18.6% increase (95% CI 1.9-35.2)
Absolute Event Rate: 115% vs 97%
p-value: p=.037
Open-chest pulsed electric field ablation of cardiac ganglionated plexi is feasible and effectively alters markers of cardiac autonomic tone without acute collateral tissue injury in a canine model.
May support autonomic modulation in AF ablation; leaves open clinical translation from this acute canine model.
This study aimed to evaluate the safety and acute effect on markers of cardiac autonomic tone following pulsed electric fields (PEFs) delivered to epicardial ganglionated plexi (GP) during a cardiac surgical procedure. Ablation of GP as a treatment for atrial fibrillation (AF) has shown promise, but thermal ablation energy sources are limited by the risk of inadvertent collateral tissue injury. In acute canine experiments, median sternotomy was performed to facilitate the identification of 5 epicardial GP regions using an anatomy-guided approach. Each site was targeted with saline-irrigated PEF (1000 V, 100 s, 10 electrocardiogram [ECG]-synchronized pulse sequences). Atrial effective refractory period (AERP) and local electrogram (EGM) amplitude were measured before and after each treatment. Histology was performed on samples from treatment-adjacent structures. In 5 animals, 30 (n = 2) and 60 (n = 3) pulses were successfully delivered to each of the 5 target sites. There was no difference in local atrial EGM amplitude before and after PEF application at each site (1.83 0.41 vs. 1.92 0.53 mV, P = .72). The mean AERP increased from 97 15 ms at baseline to 115 7 ms following treatment at all sites (18.6% increase; 95% confidence interval, 1.9-35.2; P = .037). There were no sustained ventricular arrhythmias or acute evidence of ischemia following delivery. Histology showed complete preservation of adjacent atrial myocardium, phrenic nerves, pericardium, and esophagus. Use of PEF to target regions rich in cardiac GP in open-chest canine experiments was feasible and effective at acutely altering markers of cardiac autonomic tone.
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Zyl et al. (2022) studied Atrial fibrillation (canine model) (n=5). Pulsed electric field (PEF) ablation vs. Baseline was evaluated on Mean atrial effective refractory period (AERP) (18.6% increase, 95% CI 1.9-35.2, p=.037). Pulsed electric field ablation of epicardial ganglionated plexi in an open-chest canine model acutely increased the mean atrial effective refractory period by 18.6% without causing myocardial injury.
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