Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;8(9):1106-1118.
doi: 10.1016/j.jacep.2022.06.002. Epub 2022 Jul 27.

Bipolar Electroporation Across the Interventricular Septum: Electrophysiological, Imaging, and Histopathological Characteristics

Martin van Zyl  1 , Thomas P Ladas  2 , Jason A Tri  2 , Omar Z Yasin  2 , Adetola O Ladejobi  2 , Nicholas Y Tan  2 , Georgios Christopoulos  2 , Noah Schneider  2 , David J Danitz  3 , Darin Uecker  3 , Christopher V DeSimone  2 , Ammar M Killu  2 , Elad Maor  4 , Samuel J Asirvatham  2
Affiliations
Free article

Bipolar Electroporation Across the Interventricular Septum: Electrophysiological, Imaging, and Histopathological Characteristics

Martin van Zyl et al. JACC Clin Electrophysiol. 2022 Sep.
Free article

Abstract

Background: Pulsed electric field (PEF) ablation is an emerging modality for the treatment of cardiac arrhythmias. Data regarding effects on the interventricular septum are limited, and the optimal delivery protocol and electrode configuration remain undefined.

Objectives: This study sought to evaluate the electrophysiological, imaging, and histological characteristics of bipolar direct-current PEF delivered across the interventricular septum.

Methods: PEF was applied between identical solid-tip ablation catheters positioned on either side of the septum in a chronic canine model. Intracardiac and surface electrophysiological data were recorded following delivery. In 4 animals, cardiac magnetic resonance (CMR) was performed early (6 ± 2 days) and late (30 ± 2 days) postablation. After 4 weeks of survival, cardiac specimens were sectioned for histopathological analysis.

Results: In 8 canines, PEF was delivered in 27 separate septal sites (45 ± 17 J/site) with either microsecond or nanosecond PEF. Acute complications included transient complete atrioventricular block in 5 animals (63%) after delivery at the anterobasal septum, with right bundle branch block persisting in 3 (38%). Ventricular fibrillation occurred in 1 animal during microsecond but not nanosecond PEF. Postprocedural CMR showed prominent edema and significant left ventricular systolic dysfunction, which recovered with late imaging. At 4 weeks, 36 individual well-demarcated lesions were demonstrated by CMR and histopathology. Lesion depth measured by histology was 2.6 ± 2.1 mm (maximum 10.9 mm and near transmural).

Conclusions: Bipolar PEF ablation of the interventricular septum is feasible and can produce near transmural lesions. Myocardial stunning, edema, and conduction system injury may occur transiently. Further studies are required to optimize safe delivery and efficacious lesions.

Keywords: electroporation; pulsed electric fields; pulsed field ablation; ventricular ablation.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures Funding for this work was provided through benefactor endowment to the Mayo Clinic Department of Cardiovascular Medicine and intramural funding (awarded to Dr Asirvatham). Drs Tri, Desimone, Killu, Maor, and Asirvatham have intellectual property claims involving the techniques used in this study. Mrs Danitz and Uecker are employed by Pulse Biosciences Inc, the manufacturer of the nanosecond pulse generator used in this study. Dr Asirvatham has received speaking/honoraria from Abbott, Biosense Webster, Biotronik, Boston Scientific, Medtronic, and Zoll. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Publication types

LinkOut - more resources