Muscle contractions and pain sensation accompanying high-frequency electroporation pulses

Cvetkoska, Aleksandra; Maček-Lebar, Alenka; Trdina, Peter; Miklavčič, Damijan; Reberšek, Matej

doi:10.1038/s41598-022-12112-9

Cited by 32 publications

(28 citation statements)

References 84 publications

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“…In this regard, it must me noted that PFA has shown promising results in terms of reducing the risk of injury to collateral tissues such as the phrenic nerve and most critically, the esophagus, or avoiding other commonly observed effects in RFA such as pulmonary veins stenosis 18 – 23 . Also a recent clinical study has demonstrated that for short (1 or 2 µs) biphasic high-frequency pulses with short interphase and interpulse delays reduces muscle contractions in healthy patients, and also the pain sensation 24 .…”

Section: Introductionmentioning

confidence: 99%

A computational comparison of radiofrequency and pulsed field ablation in terms of lesion morphology in the cardiac chamber

Gómez-Barea

García-Sánchez

Ivorra

2022

Sci Rep

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Pulsed Field Ablation (PFA) has been developed over the last years as a novel electrical ablation technique for treating cardiac arrhythmias. It is based on irreversible electroporation which is a non-thermal phenomenon innocuous to the extracellular matrix and, because of that, PFA is considered to be safer than the reference technique, Radiofrequency Ablation (RFA). However, possible differences in lesion morphology between both techniques have been poorly studied. Simulations including electric, thermal and fluid physics were performed in a simplified model of the cardiac chamber which, in essence, consisted of a slab of myocardium with blood in motion on the top. Monopolar and bipolar catheter configurations were studied. Different blood velocities and catheter orientations were assayed. RFA was simulated assuming a conventional temperature-controlled approach. The PFA treatment was assumed to consist in a sequence of 20 biphasic bursts (100 µs duration). Simulations indicate that, for equivalent lesion depths, PFA lesions are wider, larger and more symmetrical than RFA lesions for both catheter configurations. RFA lesions display a great dependence on blood velocity while PFA lesions dependence is negligible on it. For the monopolar configuration, catheter angle with respect to the cardiac surface impacted both ablation techniques but in opposite sense. The orientation of the catheter with respect to blood flow direction only affected RFA lesions. In this study, substantial morphological differences between RFA and PFA lesions were predicted numerically. Negligible dependence of PFA on blood flow velocity and direction is a potential important advantage of this technique over RFA.

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Section: Introductionmentioning

confidence: 99%

A computational comparison of radiofrequency and pulsed field ablation in terms of lesion morphology in the cardiac chamber

Gómez-Barea

García-Sánchez

Ivorra

2022

Sci Rep

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“…The parameters and catheters used in our animal and clinical trials were based on a large body of previous animal and cell experiments ( 1 , 2 ). We used biphasic asymmetric pulses, which have been shown to have advantages such as lower ablation thresholds and less muscle contraction ( 1 , 14 – 16 ). However, the timing of apoptosis may vary with different pulse parameters or catheters due to the existence of grading effects ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

Study on the process of cardiomyocyte apoptosis after pulsed field ablation

Fan

Jia

Cui

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThe development of pulsed field ablation (PFA) as a new technique for pulmonary vein isolation (PVI) has been advancing rapidly in recent years. My team's previous work has shown the safety and long-term efficacy of bipolar asymmetric pulses in animal experiments. However, in ongoing clinical trials, we have observed that atrial fibrillation (AF) recurs in some patients after surgery, but the rhythm returns to normal without surgical intervention after seven days, and there is no recurrence in the follow-up.Based on this observation, we have proposed the hypothesis that myocardial cell apoptosis may play a role in AF recurrence after PFA. Our team has designed animal experiments to verify this hypothesis and further investigate the process of PFA-induced cardiomyocyte apoptosis.MethodsPulse field ablation was performed on 15 dogs and the animals were dissected at various time points after the operation (immediately, 3 days, 7 days, 30 days, and 150 days). To obtain ablation voltage maps, electroanatomic mapping was performed before and after ablation and before dissection. The ablation area was also subjected to HE and TUNEL staining to analyze apoptosis and pathological results.ResultsThe edge area of the ablation in the pulmonary vein (PV) demonstrated continuous dynamic changes from 0 to 2 h after the operation and a slight expansion of the ablation range was observed in the long-term follow-up. Myocardial intima hyperplasia was observed from 0 to 7 days. Local apoptosis was detected from 0 to 2 h and massive, concentrated apoptosis was observed at 3 days. No recurrence of apoptosis was seen at 7 days, 30 days, and 150 days.ConclusionsThe results of this study showed that after pulse field ablation (PFA), the central ablation area of the canine heart experienced immediate cardiomyocyte death. Meanwhile, cardiomyocytes in the edge ablation area underwent apoptosis, which began from 0 to 2 h post-operation and ended between 3 and 7 days. This process occurred simultaneously with intimal thickening.In the long-term follow-up group, there was no recovery of isolation and no recurrence of cardiomyocyte apoptosis, and no change was observed in the endomyocardial intima.

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“…The interval of BP in changing the EP efficiency, regulating the BPC and BPE has been extensively studied [32][33], which also has a significant role in high-frequency biphasic pulses (HF-IRE) treatment outcomes and may improve the effectiveness of HF-IRE as clinical tissue ablation modality [34][35] [36][37] [38]. In this study, we varied the intervals within BP to observe the PM-EP dynamic at molecular level.…”

Section: Discussionmentioning

confidence: 99%

Molecular dynamics study of phospholipid membrane electroporation induced by bipolar pulses with different intervals

Guo

Zhou

Wang

2022

Preprint

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In this study, PM-EP induced by bipolar pulses with different intervals was investigated by all-atom molecular dynamics simulation. Firstly, PM-EP was formed during the positive pulse of 2ns and 0.5V/nm, then the effects of various intervals of 0, 1, 5, 10ns on PM-EP evolution were investigated, and the dynamic changes of different degrees of PM-EP induced by following negative pulses of 2ns and 0.5V/nm were analyzed. The elimination of the PM-EP during the interval of bipolar pulses were determined and it was related to the degrees of PM-EP and the time of intervals, then the degrees of PM-EP at the end of the intervals were classified and quantitatively defined, namely, Resealing, Destabilizing and Retaining state. These three states appeared due to the combined effect of both the preceding positive pulse and the interval. Furthermore, the evolution of PM-EP in resealing state under negative pulses was similar to that of positive pulses as evidenced by EP formation time and degree of PM-EP, the destabilizing state had the same trends as the resealing state except that the re-electroporation of phospholipid membrane appeared faster and larger degree of EP obtained with the same pulse exposure time. Regarding the retaining state, the negative pulses enhanced PM-EP with more profound water bridges, which can be considered as the effect of electric field superposition. These results can improve our understanding of the fundamental mechanism of bipolar pulse-induced PM-EP.

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Muscle contractions and pain sensation accompanying high-frequency electroporation pulses

Cited by 32 publications

References 84 publications

A computational comparison of radiofrequency and pulsed field ablation in terms of lesion morphology in the cardiac chamber

A computational comparison of radiofrequency and pulsed field ablation in terms of lesion morphology in the cardiac chamber

Study on the process of cardiomyocyte apoptosis after pulsed field ablation

Molecular dynamics study of phospholipid membrane electroporation induced by bipolar pulses with different intervals

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