Key result
In vitro, millisecond anodal IRE-pulses produced significantly less and smaller gas bubbles than millisecond cathodal IRE-pulses (P < .001 for volume difference).
Why the study?
Gaseous microemboli during catheter ablation can cause asymptomatic ischemic events, but gas formation had not been studied for nonarcing irreversible electroporation ablation.
Does the polarity of millisecond IRE-pulses affect gas formation during catheter ablation in vitro?
Does the polarity of millisecond IRE-pulses affect gas formation during catheter ablation in vitro?
Answers are grounded in this paper and cite their sources.
In vitro, anodal millisecond IRE-pulses produce significantly less and smaller gas bubbles compared to cathodal pulses, suggesting a potential strategy to reduce gaseous microemboli during ablation.
INTRODUCTION: Recent studies demonstrated that irreversible electroporation (IRE) ablation may be an alternative method for thermal ablation for pulmonary vein isolation. Development of gaseous microemboli during catheter ablation might lead to asymptomatic ischemic events and is therefore an important research topic. Gas formation during arcing with direct current catheter ablation has been studied in the past, however not for nonarcing IRE-ablation. OBJECTIVE: The aim of the present study was to visualize, quantify, and characterize gas formation during nonarcing millisecond IRE-pulses using a multielectrode circular catheter. METHODS: In vitro, gas formation during IRE-pulses was studied using a high-speed imaging, direct volume measurements, and a bubble counter. Gas formation was compared between cathodal and anodal IRE-pulses and between a small and large catheter hoop diameter. RESULTS: High-speed images showed the location and dynamics of gas formation during cathodal and anodal millisecond IRE-pulses. The direct volume measurements demonstrated a significantly larger volume for cathodal than for anodal IRE-pulses (P < .001), and no significant difference between small and large hoop diameters. A strong linear relationship was found between delivered charge and total gas volume (r = 0.99). Bubble counter measurements showed that cathodal IRE-pulses produced more and larger gas bubbles than anodal IRE-pulses. The ratio of total gas volume between cathodal and anodal IRE-pulses is different as predicted from electrolysis theory. CONCLUSION: In vitro, millisecond anodal IRE-pulses produce significantly less and smaller gas bubbles than millisecond cathodal IRE-pulses. In vivo experiments are required to investigate the clinical implication of these observations.
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Es et al. (2019) studied Pulmonary vein isolation. Cathodal millisecond IRE-pulses vs. Anodal millisecond IRE-pulses was evaluated on Gas formation volume (p=< .001). In vitro, millisecond anodal IRE-pulses produced significantly less and smaller gas bubbles than millisecond cathodal IRE-pulses (P < .001 for volume difference).
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