In vivo characterization and numerical simulation of prostate properties for non-thermal irreversible electroporation ablation

Neal, Robert E.; Millar, Jeremy; Kavnoudias, Helen; Royce, Peter; Rosenfeldt, Franklin; Pham, Alan; Smith, R. L.; Davalos, Rafael V.; Thomson, Kenneth R.

doi:10.1002/pros.22760

Cited by 110 publications

(92 citation statements)

References 47 publications

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“…Given the incredible redundancy and arborizing nature of Purkinje fibers,23 coupled with the trabeculated nature of the left ventricle, an approach using electroporation may be a promising alternative. Consistent with other noncardiac electroporation patterns of injury, the extent of injury found was not solely reliant on contact and confined to the tissue adjacent to the catheter tip, but a result of the electric field (V/cm) created 24, 25, 26, 27. The ablation electrode was deliberately kept at least 10 mm (and up to 25 mm) away from the Purkinje that was being actively recorded.…”

Section: Discussionsupporting

confidence: 70%

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Livia

Sugrue

Witt

et al. 2018

JAHA

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BackgroundThe Purkinje network appears to play a pivotal role in the triggering as well as maintenance of ventricular fibrillation. Irreversible electroporation (IRE) using direct current has shown promise as a nonthermal ablation modality in the heart, but its ability to target and ablate the Purkinje tissue is undefined. Our aim was to investigate the potential for selective ablation of Purkinje/fascicular fibers using IRE.Methods and ResultsIn an ex vivo Langendorff model of canine heart (n=8), direct current was delivered in a unipolar manner at various dosages from 750 to 2500 V, in 10 pulses with a 90‐μs duration at a frequency of 1 Hz. The window of ventricular fibrillation vulnerability was assessed before and after delivery of electroporation energy using a shock on T‐wave method. IRE consistently eradicated all Purkinje potentials at voltages between 750 and 2500 V (minimum field strength of 250–833 V/cm). The ventricular electrogram amplitude was only minimally reduced by ablation: 0.6±2.3 mV (P=0.03). In 4 hearts after IRE delivery, ventricular fibrillation could not be reinduced. At baseline, the lower limit of vulnerability to ventricular fibrillation was 1.8±0.4 J, and the upper limit of vulnerability was 19.5±3.0 J. The window of vulnerability was 17.8±2.9 J. Delivery of electroporation energy significantly reduced the window of vulnerability to 5.7±2.9 J (P=0.0003), with a postablation lower limit of vulnerability=7.3±2.63 J, and the upper limit of vulnerability=18.8±5.2 J.ConclusionsOur study highlights that Purkinje tissue can be ablated with IRE without any evidence of underlying myocardial damage.

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Section: Discussionsupporting

confidence: 70%

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Livia

Sugrue

Witt

et al. 2018

JAHA

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“…Previously, Neal et al described two human IRE cases performed without serious adverse events followed by uncomplicated radical prostatectomies. The histology shows tissue necrosis plus a variable extent of reactive stromal fibrosis, inflammatory infiltrates and regenerative changes in epithelial lining of prostatic ducts 32. So far, several focal therapies have been proposed and investigated for prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The histology shows tissue necrosis plus a variable extent of reactive stromal fibrosis, inflammatory infiltrates and regenerative changes in epithelial lining of prostatic ducts. 32 So far, several focal therapies have been proposed and investigated for prostate cancer. In the past, the first phase I/II assessments of new focal ablation modalities have often been skipped and these methods were immediately used in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

The safety and efficacy of irreversible electroporation for the ablation of prostate cancer: a multicentre prospective human in vivo pilot study protocol

et al. 2014

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IntroductionCurrent surgical and ablative treatment options for prostate cancer have a relatively high incidence of side effects, which may diminish the quality of life. The side effects are a consequence of procedure-related damage of the blood vessels, bowel, urethra or neurovascular bundle. Ablation with irreversible electroporation (IRE) has shown to be effective in destroying tumour cells and harbours the advantage of sparing surrounding tissue and vital structures. The aim of the study is to evaluate the safety and efficacy and to acquire data on patient experience of minimally invasive, transperineally image-guided IRE for the focal ablation of prostate cancer.Methods and analysisIn this multicentre pilot study, 16 patients with prostate cancer who are scheduled for a radical prostatectomy will undergo an IRE procedure, approximately 30 days prior to the radical prostatectomy. Data as adverse events, side effects, functional outcomes, pain and quality of life will be collected and patients will be controlled at 1 and 2 weeks post-IRE, 1 day preprostatectomy and postprostatectomy. Prior to the IRE procedure and the radical prostatectomy, all patients will undergo a multiparametric MRI and contrast-enhanced ultrasound of the prostate. The efficacy of ablation will be determined by whole mount histopathological examination, which will be correlated with the imaging of the ablation zone.Ethics and disseminationThe protocol is approved by the ethics committee at the coordinating centre (Academic Medical Center (AMC) Amsterdam) and by the local Institutional Review Board at the participating centres. Data will be presented at international conferences and published in peer-reviewed journals.ConclusionsThis pilot study will determine the safety and efficacy of IRE in the prostate. It will show the radiological and histopathological effects of IRE ablations and it will provide data to construct an accurate treatment planning tool for IRE in prostate tissue.Trial registration numberClinicaltrials.gov database: NCT01790451.

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“…IRE has been promoted by different groups as a non-thermal treatment option where ablation only occurs between the inserted electrodes [22,23,24]. The latest publication by van Gemert et al [25] showed a thermal effect in tissues between 67 and 92 °C by IRE.…”

Section: Discussionmentioning

confidence: 99%

Role of Focal Therapy with High-Intensity Focused Ultrasound in the Management of Clinically Localized Prostate Cancer

et al. 2015

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Overtreatment of prostate cancer (PC) remains one of the main burdens in uro-oncology. Focal therapy may be a reasonable alternative with less side effects and morbidity. Application of high-intensity focused ultrasound (HIFU) induces immediate and irreversible coagulation. The treatment leads to consecutive necrosis with sharply delineated margins, making HIFU a promising tool for the focal therapy of localized PC. Unlike radiation, the treatment leaves no collateral damage outside of the heated tissue, allowing repeated use of HIFU, if necessary. In case of non-organ-confined relapse, additional radical salvage therapy can be performed. This review gives an overview of the existing evidence on focal HIFU. Today, 3 HIFU devices are approved for the treatment of localized PC: Sonablate™, Ablatherm™ and the FocalOne™ device. In summary, the first published results of focal HIFU are promising. The quality of life and potency of the patients are well preserved. Therefore, HIFU treatment, and especially focal ablation of tumor foci, seems to be a safe alternative to standard treatment, with low side effects. The oncologic results seem satisfactory but need further follow-up to validate this practice of PC control.

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In vivo characterization and numerical simulation of prostate properties for non-thermal irreversible electroporation ablation

Cited by 110 publications

References 47 publications

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

Elimination of Purkinje Fibers by Electroporation Reduces Ventricular Fibrillation Vulnerability

The safety and efficacy of irreversible electroporation for the ablation of prostate cancer: a multicentre prospective human in vivo pilot study protocol

Role of Focal Therapy with High-Intensity Focused Ultrasound in the Management of Clinically Localized Prostate Cancer

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