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. 2018 Aug;4(8):987-995.
doi: 10.1016/j.jacep.2018.04.005. Epub 2018 May 11.

Ablation of Atrial Fibrillation With Pulsed Electric Fields: An Ultra-Rapid, Tissue-Selective Modality for Cardiac Ablation

Vivek Y Reddy  1 , Jacob Koruth  2 , Pierre Jais  3 , Jan Petru  4 , Ferdinand Timko  5 , Ivo Skalsky  5 , Robert Hebeler  6 , Louis Labrousse  7 , Laurent Barandon  7 , Stepan Kralovec  4 , Moritoshi Funosako  4 , Boochi Babu Mannuva  4 , Lucie Sediva  4 , Petr Neuzil  4
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Free article

Ablation of Atrial Fibrillation With Pulsed Electric Fields: An Ultra-Rapid, Tissue-Selective Modality for Cardiac Ablation

Vivek Y Reddy et al. JACC Clin Electrophysiol. 2018 Aug.
Free article

Abstract

Objectives: The authors report the first acute clinical experience of atrial fibrillation ablation with PEF-both epicardial box lesions during cardiac surgery, and catheter-based PV isolation.

Background: Standard energy sources rely on time-dependent conductive heating/cooling and ablate all tissue types indiscriminately. Pulsed electric field (PEF) energy ablates nonthermally by creating nanoscale pores in cell membranes. Potential advantages for atrial fibrillation ablation include: 1) cardiomyocytes have among the lowest sensitivity of any tissue to PEF-allowing tissue selectivity, thereby minimizing ablation of nontarget collateral tissue; 2) PEF is delivered rapidly over a few seconds; and 3) the absence of coagulative necrosis obviates the risk of pulmonary vein (PV) stenosis.

Methods: PEF ablation was performed using a custom over-the-wire endocardial catheter for percutaneous transseptal PV isolation, and a linear catheter for encircling the PVs and posterior left atrium during concomitant cardiac surgery. Endocardial voltage maps were created pre- and post-ablation. Continuous and categorical data are summarized and presented as mean ± SD and frequencies.

Results: At 2 centers, 22 patients underwent ablation under general anesthesia: 15 endocardial and 7 epicardial. Catheter PV isolation was successful in all 57 PVs in 15 patients (100%) using 3.26 ± 0.5 lesions/PV: procedure time 67 ± 10.5 min, catheter time (PEF catheter entry to exit) 19 ± 2.5 min, total PEF energy delivery time <60 s/patient, and fluoroscopy time 12 ± 4.0 min. Surgical box lesions were successful in 6 of 7 patients (86%) using 2 lesions/patient. The catheter time for epicardial ablation was 50.7 ± 19.5 min. There were no complications.

Conclusions: These data usher in a new era of tissue-specific, ultrarapid ablation of atrial fibrillation.

Keywords: atrial fibrillation; catheter ablation; electroporation; pulmonary vein isolation; pulsed electric field.

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