Key result
Catheter ablation shocks depress action potentials and cause membrane hang-up, potentially explaining brief post-ablation arrhythmias.
Cellular studies demonstrate that electrical shocks cause widespread electrophysiological depression and membrane 'hang-up' which may explain post-ablation arrhythmias, whereas laser photoablation produces more focal injury.
May underlie transient post-ablation arrhythmias; leaves open optimal energy modalities for clinical use.
Clinical and animal investigations have pointed out that high energy electrical shocks are associated with the development of cardiac arrhythmias and with variable success in permanent ablation. The effects of electrode configuration and location on the size of the recorded electrogram was investigated to help explain variable catheter ablation results. We analyzed the cellular effects of catheter ablation shocks and found depression of resting potential, action potential amplitude, dV/dt and action potential duration. The most severe effects were noted with high current densities in tissues located between the cathode and anode. Damage was worse nearest the cathode. Similar cellular studies were completed using argon laser photoablation. Again, there was a decrease in resting potential, action potential amplitude and dV/dt. Laser energy led to a more focal region of myocardium void of action potentials and the border zone of injury was smaller. We also investigated the effects of lower energy shocks (1 to 10 joule) on cardiac tissues. Using microelectrodes, we observed that the membrane potential can "hang up" at the depolarized levels for varying periods of time and that conduction is altered during this membrane "hang-up" period. The duration and membrane hang-up level correlated with shock intensity and shock duration. Sequential shocks resulted in additive membrane "hang-up". We believe that membrane hang-up may be associated with brief arrhythmias observed following catheter ablation since conduction, refractoriness and excitability are all altered.
No takes yet. Share an insight, caveat, or question.
Schäfer et al. (1989) studied Cardiac arrhythmias. Catheter ablation shocks and argon laser photoablation was evaluated on Cellular electrophysiological effects (resting potential, action potential amplitude, dV/dt, action potential duration). Catheter ablation shocks caused depression of cellular action potentials and membrane hang-up at depolarized levels, which may explain brief arrhythmias following ablation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: