Single pulse irreversible electroporation safely achieved acute bidirectional electrical pulmonary vein isolation in 100% of targeted veins (40/40) with no periprocedural complications.
Does single pulse irreversible electroporation achieve safe and feasible pulmonary vein isolation in patients with symptomatic atrial fibrillation?
Single pulse irreversible electroporation is a feasible and safe novel nonthermal ablation modality for achieving acute pulmonary vein isolation in patients with atrial fibrillation.
BACKGROUND: Irreversible electroporation (IRE) is a promising new nonthermal ablation technology for pulmonary vein (PV) isolation in patients with atrial fibrillation. Experimental data suggest that IRE ablation produces large enough lesions without the risk of PV stenosis, artery, nerve, or esophageal damage. This study aimed to investigate the feasibility and safety of single pulse IRE PV isolation in patients with atrial fibrillation. METHODS: Ten patients with symptomatic paroxysmal or persistent atrial fibrillation underwent single pulse IRE PV isolation under general anesthesia. Three-dimensional reconstruction and electroanatomical voltage mapping (EnSite Precision, Abbott) of left atrium and PVs were performed using a conventional circular mapping catheter. PV isolation was performed by delivering nonarcing, nonbarotraumatic 6 ms, 200 J direct current IRE applications via a custom nondeflectable 14-polar circular IRE ablation catheter with a variable hoop diameter (16-27 mm). A deflectable sheath (Agilis, Abbott) was used to maneuver the ablation catheter. A minimum of 2 IRE applications with slightly different catheter positions were delivered per vein to achieve circular tissue contact, even if PV potentials were abolished after the first application. Bidirectional PV isolation was confirmed with the circular mapping catheter and a post ablation voltage map. After a 30-minute waiting period, adenosine testing (30 mg) was used to reveal dormant PV conduction. RESULTS: All 40 PVs could be successfully isolated with a mean of 2.4±0.4 IRE applications per PV. Mean delivered peak voltage and peak current were 2154±59 V and 33.9±1.6 A, respectively. No PV reconnections occurred during the waiting period and adenosine testing. No periprocedural complications were observed. CONCLUSIONS: In the 10 patients of this first-in-human study, acute bidirectional electrical PV isolation could be achieved safely by single pulse IRE ablation.
Loh et al. (Tue,) conducted a other in Symptomatic paroxysmal or persistent atrial fibrillation (n=10). Single pulse irreversible electroporation (IRE) was evaluated on Successful pulmonary vein isolation and periprocedural complications. Single pulse irreversible electroporation safely achieved acute bidirectional electrical pulmonary vein isolation in 100% of targeted veins (40/40) with no periprocedural complications.