A feasibility study of noninvasive ablation of ventricular tachycardia using high‐intensity focused ultrasound

Lü, Fei; Huang, Wei; Benditt, David G.

doi:10.1111/jce.13459

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…In a closed-chest animal model applying a noninvasive HIFU system, as it is clinically used to target human neoplasms 43 , it was shown that with ablation energies of 400W for 2-4 seconds, transmural and localized lesions could be created without apparent injury to skin, lung or pericardium. 44 Yet, thus far no human feasibility studies have been published.…”

Section: High-intensity Focused Ultrasound Evidencementioning

confidence: 99%

A Review of Novel and Emerging Non-Radiofrequency Ablation Modalities for Ventricular Arrhythmias: Towards an Individualized Substrate-guided Choice of Ablation Technology

Tonko,

Lambiase

2023

European Journal of Arrhythmia &Amp; Electrophysiology

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Radiofrequency (RF) catheter ablation is the first-line modality for ventricular tachycardia (VT) ablation. Yet, recurrence rates of scar-related VTs are substantial, particularly in the complex and heterogenous nonischaemic cardiomyopathies. To address the still unmet need of delivering durable lesions to all functionally critical areas, including in conventionally inaccessible (e.g. deep mid-myocardial) or prohibitive areas (e.g. proximity to coronaries), a number of alternative interventional approaches have been proposed. Multiple reviews have summarized advanced RF strategies of how to target challenging VT substrates, but the spectrum for ablation modalities to treat ventricular arrhythmias is also rapidly growing beyond the well-established RF technology. Alternative energy sources and delivery modes to treat ventricular arrhythmias include ultra-low temperature cryoablation, pulsed field ablation, laser ablation, high-intensity focused ultrasound ablation and shock wave ablation. Stereotactic body radiation, chemical ablation with ethanol and autonomous nervous system modulation are further promising technologies to reduce arrhythmia burden. The wide variety of emerging approaches and techniques offers new opportunities to select tailored VT ablation strategies based on the individual substrate and VT characteristics. This review aims to present rational and evidence of emerging and cutting-edge non-RF VT ablation technologies to provide the reader with a compact update of this rapidly evolving field of cardiac electrophysiology. This will be complemented by a discussion about the specific VT substrates for which the individual technologies may prove to be most useful.

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Section: High-intensity Focused Ultrasound Evidencementioning

confidence: 99%

A Review of Novel and Emerging Non-Radiofrequency Ablation Modalities for Ventricular Arrhythmias: Towards an Individualized Substrate-guided Choice of Ablation Technology

Tonko,

Lambiase

2023

European Journal of Arrhythmia &Amp; Electrophysiology

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“…In the last 20 years, investigations into the application of HIFU in the cardiovascular eld have been ongoing, mainly including myocardial ablation and electrophysiological ablation [5][6][7] . Previous studies have established several pathways, including thoracotomy [8] , transthoracic 9 , trans-vascular 10 , and transesophageal 11 . In 2007, Boris Schmidt rst reported the use of a steerable HIFU balloon catheter for radiofrequency ablation (RFA) of the pulmonary vein ostium in patients with atrial brillation, with the success rate of pulmonary vein isolation reaching 89% 12 .…”

Section: Introductionmentioning

confidence: 99%

High-intensity Focused Ultrasound In Interventricular Septal Myocardial Ablation: Effects Of Coronary Flow

Ren

Sui

Gong

et al. 2022

Preprint

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Background High-intensity focused ultrasound (HIFU) can generate necrotic damage in deep tissues through thermal ablation and cavitation, without significant damage to the surrounding tissues. The high blood perfusion of heat affects the deposition of energy. The aim of this study was to evaluate the effect of cooling of coronary blood flow for high-intensity focused ultrasound ablation. Methods Continuous and pulsed HIFU (2000 J) at duty cycles (DCs) of 100% and 20% were examined for their capacity to ablate the perfused porcine heart tissue in vitro. After ablation, gray scale changes and pathological features were observed or measured, and tissue necrosis area and volume were calculated. Results The cardiomyocytes in the lesions underwent necrosis with a clear boundary. The endocardium was intact without necrosis. The three-dimensional morphology of the lesions appeared approximately as ellipsoids. With the increase of perfusion speed, the necrotic volume in the target area was gradually reduced. Conclusions HIFU has the potential to become a new minimally invasive surgery for ventricular septal myocardial ablation. Reducing coronary blood flow can improve the ablation effect.

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“…In ophthalmology, the hypotensive effect of high-intensity focused ultrasound (HIFU) in managing intraocular pressure in dogs with primary glaucoma was demonstrated successfully without observing intra-operative complications. [ 26 ] The technique has also been tested with promising results in interventional cardiology strategies such as for managing ventricular arrhythmia,[ 27 28 ] cardiac ablation,[ 29 30 ] and atrial fibrillation treatment. [ 31 32 ] The effectiveness of HIFU in treating drug-resistant hypertension via bilateral renal nerves ablation was investigated in canine models.…”

Section: Introductionmentioning

confidence: 99%

A High Intensity Focused Ultrasound System for Veterinary Oncology Applications

Spanoudes

Evripidou

Giannakou

et al. 2021

Journal of Medical Ultrasound

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Background: Magnetic resonance-guided focused ultrasound surgery is an incisionless energy-based thermal method that is used for ablating tumors in the veterinary clinic. Aims and Objectives: In this article we describe a prototype of a veterinary system compatible with magnetic resonance imaging intended for small-to-medium-sized companion animals that was developed and tested in vivo in adult rabbits. Methods: Real-time monitoring of the ablation during the experiment was possible with MR thermometry. Experiments involved thermal monitoring of sonications applied in the thigh of the rabbits. A 38-mm diameter transducer operating at 2.6 MHz was used with a 60-mm-focal length. The robotic system employed 3 linear axes and one angular axis. For this study, only X and Y axis were enabled. Due to the target size limitations, motion in Z and Θ was not needed. The functionality of the positioning device was evaluated by means of MR thermometry, demonstrating sufficient heating and accurate motion in both axes of operation. Results: The postmortem findings confirm the ability of the system to induce thermal ablations in vivo in the absence of adverse effects. Conclusions: The device is a reliable and affordable solution for companion animal hospitals, offering and additional tool for the veterinary oncology society.

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A feasibility study of noninvasive ablation of ventricular tachycardia using high‐intensity focused ultrasound

Abstract: This pilot study suggests that HIFU is potentially useful for noninvasive ablation of targeted, localized myocardial tissues, and it may be potentially applicable for VT ablation, particularly for those with intramyocardial/epicardial origins.

Cited by 11 publications

References 17 publications

A Review of Novel and Emerging Non-Radiofrequency Ablation Modalities for Ventricular Arrhythmias: Towards an Individualized Substrate-guided Choice of Ablation Technology

A Review of Novel and Emerging Non-Radiofrequency Ablation Modalities for Ventricular Arrhythmias: Towards an Individualized Substrate-guided Choice of Ablation Technology

High-intensity Focused Ultrasound In Interventricular Septal Myocardial Ablation: Effects Of Coronary Flow

A High Intensity Focused Ultrasound System for Veterinary Oncology Applications

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