Key result
Anodal irreversible electroporation cuts gas formation ~99% vs cathodal applications in preclinical testing.
Why the study?
Delivery of current through blood during IRE ablation causes electrolysis, and resulting gaseous microemboli might be associated with myocardial damage or cerebral ischaemic events.
Does anodal irreversible electroporation reduce the amount of gaseous microemboli compared to cathodal IRE and RF ablation in an in vivo porcine model?
Does anodal irreversible electroporation reduce the amount of gaseous microemboli compared to cathodal IRE and RF ablation in an in vivo porcine model?
Answers are grounded in this paper and cite their sources.
Anodal IRE produces significantly less gaseous microemboli than cathodal IRE and RF ablation in an in vivo porcine model, suggesting a potential safety advantage regarding embolic risk.
AIMS: Irreversible electroporation (IRE) ablation is a non-thermal ablation method based on the application of direct current between a multi-electrode catheter and skin electrode. The delivery of current through blood leads to electrolysis. Some studies suggest that gaseous (micro)emboli might be associated with myocardial damage and/or (a)symptomatic cerebral ischaemic events. The aim of this study was to compare the amount of gas generated during IRE ablation and during radiofrequency (RF) ablation. METHODS AND RESULTS: In six 60-75 kg pigs, an extracorporeal femoral shunt was outfitted with a bubble-counter to detect the size and total volume of gas bubbles. Anodal and cathodal 200 J IRE applications were delivered in the left atrium (LA) using a 14-electrode circular catheter. The 30 and 60 s 40 W RF point-by-point ablations were performed. Using transoesophageal echocardiography (TOE), gas formation was visualized. Average gas volumes were 0.6 ± 0.6 and 56.9 ± 19.1 μL (P < 0.01) for each anodal and cathodal IRE application, respectively. Also, qualitative TOE imaging showed significantly less LA bubble contrast with anodal than with cathodal applications. Radiofrequency ablations produced 1.7 ± 2.9 and 6.7 ± 7.4 μL of gas, for 30 and 60 s ablation time, respectively. CONCLUSION: Anodal IRE applications result in significantly less gas formation than both cathodal IRE applications and RF applications. This finding is supported by TOE observations.
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Groen et al. (2020) studied Healthy (in vivo porcine model for ablation) (n=6). Anodal irreversible electroporation (IRE) vs. Cathodal IRE and Radiofrequency (RF) ablation was evaluated on Total gas volume per application (p=<0.01). Anodal irreversible electroporation produced significantly less gas (0.6 μL per application) than cathodal applications (56.9 μL) or radiofrequency ablation in a porcine model.
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