Key result
Reversible pulsed electric fields transiently reduce electrogram amplitudes ~70% and terminate spontaneous tachycardias before ablation.
Why the study?
During electrophysiological mapping of tachycardias, putative target sites are often only confirmed after ablation, risking inadvertent ablation of innocent tissue. The authors investigated whether reversible pulsed electric fields could transiently suppress electrical conduction to dissect circuits in vivo.
Does reversible pulsed electric field (PF REV) application transiently suppress electrical conduction to identify critical tachycardia circuits in swine and human patients?
Does reversible pulsed electric field (PF REV) application transiently suppress electrical conduction to identify critical tachycardia circuits in swine and human patients?
Reversible pulsed electric fields can transiently block electrical conduction, offering a novel mapping tool to identify critical tachycardia circuits before delivering destructive ablation.
Answers are grounded in this paper and cite their sources.
May allow transient circuit mapping without permanent injury; leaves open whether it improves ablation outcomes in prospective trials.
BACKGROUND: During electrophysiological mapping of tachycardias, putative target sites are often only truly confirmed to be vital after observing the effect of ablation. This lack of mapping specificity potentiates inadvertent ablation of innocent cardiac tissue not relevant to the arrhythmia. But if myocardial excitability could be transiently suppressed at critical regions, their suitability as targets could be conclusively determined before delivering tissue-destructive ablation lesions. We studied whether reversible pulsed electric fields (PF REV ) could transiently suppress electrical conduction, thereby providing a means to dissect tachycardia circuits in vivo. METHODS: PF REV energy was delivered from a 9-mm lattice-tip catheter to the atria of 12 swine and 9 patients, followed by serial electrogram assessments. The effects on electrical conduction were explored in 5 additional animals by applying PF REV to the atrioventricular node: 17 low-dose (PF REV-LOW ) and 10 high-dose (PF REV-HIGH ) applications. Finally, in 3 patients manifesting spontaneous tachycardias, PF REV was applied at putative critical sites. RESULTS: In animals, the immediate post-PF REV electrogram amplitudes diminished by 74%, followed by 78% recovery by 5 minutes. Similarly, in patients, a 69.9% amplitude reduction was followed by 84% recovery by 3 minutes. Histology revealed only minimal to no focal, superficial fibrosis. PF REV-LOW at the atrioventricular node resulted in transient PR prolongation and transient AV block in 59% and 6%, while PF REV-HIGH caused transient PR prolongation and transient AV block in 30% and 50%, respectively. The 3 tachycardia patients had atypical atrial flutters (n=2) and atrioventricular nodal reentrant tachycardia. PF REV at putative critical sites reproducibly terminated the tachycardias; ablation rendered the tachycardias noninducible and without recurrence during 1-year follow-up. CONCLUSIONS: Reversible electroporation pulses can be applied to myocardial tissue to transiently block electrical conduction. This technique of pulsed field mapping may represent a novel electrophysiological tool to help identify the critical isthmus of tachycardia circuits.
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Koruth et al. (2023) studied Tachycardias (n=29). Reversible pulsed electric fields (PF REV) was evaluated on Electrogram amplitude reduction. Reversible pulsed electric fields transiently reduced electrogram amplitudes by 69.9% in patients and reproducibly terminated spontaneous tachycardias prior to ablation.
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