Pulsed field ablation as a precise approach for cardiac arrhythmia treatment via cardiac microenvironment remodeling

Teng, P. K.; Wu, Yuefeng; Chen, Ruoshi; Hong, Liangjie; Wu, Bin; Liu, Lingshan; Zhao, Haige; Wu, Shengjun

doi:10.1016/j.bioelechem.2023.108502

Cited by 2 publications

(3 citation statements)

References 28 publications

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“…PFA, although its use in AF ablation is rather recent, has already accumulated large scientific evidence on its safety and effectiveness. The first published clinical studies highlighted high efficacy of PFA in the ablation of AF, both in paroxysmal and persistent forms, obtaining intraprocedural success rates close to 100% in PVI and also very high for other lesions in the LA [56,60,61,68]. These results were obtained with few or no complications.…”

Section: Discussionmentioning

confidence: 95%

“…Despite the well-established safety profile of PFA, several aspects related to this innovative technique still require improvement. For instance, in some comparative studies between PFA and RFA regarding the incidence and severity of left circumflex arterial vasospasm during adjacent ablation along the mitral isthmus (MI), vasospasm was found to be frequent with PFA and not with RFA, but it was typically subclinical [67,68]. Another study by Kirstein B et al investigated intraluminal esophageal temperature changes during PFA for AF.…”

Section: Safety Profile Of Pulsed Field Ablationmentioning

confidence: 99%

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Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications

Pierucci,

Mariani,

Laviola

et al. 2024

JCM

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Atrial fibrillation, representing the most prevalent sustained cardiac arrhythmia, significantly impacts stroke risk and cardiovascular mortality. Historically managed with antiarrhythmic drugs with limited efficacy, and more recently, catheter ablation, the interventional approach field is still evolving with technological advances. This review highlights pulsed field ablation (PFA), a revolutionary technique gaining prominence in interventional electrophysiology because of its efficacy and safety. PFA employs non-thermal electric fields to create irreversible electroporation, disrupting cell membranes selectively within myocardial tissue, thus preventing the non-selective damage associated with traditional thermal ablation methods like radiofrequency or cryoablation. Clinical studies have consistently shown PFA’s ability to achieve pulmonary vein isolation—a cornerstone of AF treatment—rapidly and with minimal complications. Notably, PFA reduces procedure times and has shown a lower incidence of esophageal and phrenic nerve damage, two common concerns with thermal techniques. Emerging from oncological applications, the principles of electroporation provide a unique tissue-selective ablation method that minimizes collateral damage. This review synthesizes findings from foundational animal studies through to recent clinical trials, such as the MANIFEST-PF and ADVENT trials, demonstrating PFA’s effectiveness and safety. Future perspectives point towards expanding indications and refinement of techniques that promise to improve AF management outcomes further. PFA represents a paradigm shift in AF ablation, offering a safer, faster, and equally effective alternative to conventional methods. This synthesis of its development and clinical application outlines its potential to become the new standard in AF treatment protocols.

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Section: Discussionmentioning

confidence: 95%

Section: Safety Profile Of Pulsed Field Ablationmentioning

confidence: 99%

Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications

Pierucci,

Mariani,

Laviola

et al. 2024

JCM

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“…In addition, the small field of action minimizes damage to biologically active tissues outside of the electric field, such as nervous tissue, though variable non-fatal damage and regeneration have been described [ 40 ]. In addition, the non-thermal mechanism of action does not denature tissue or activate any damage-sensitive innate receptors for non-specific inflammation [ 41 ]. A minimized inflammatory response yields less fibrosis and off-target tissue damage.…”

Section: Pulsed-field Ablation For Arrhythmogenic Substrate Suppressionmentioning

confidence: 99%

Opportunities and Challenges in Catheter-Based Irreversible Electroporation for Ventricular Tachycardia

Repp,

Chinyere

2024

Pathophysiology

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The use of catheter-based irreversible electroporation in clinical cardiac laboratories, termed pulsed-field ablation (PFA), is gaining international momentum among cardiac electrophysiology proceduralists for the non-thermal management of both atrial and ventricular tachyrhythmogenic substrates. One area of potential application for PFA is in the mitigation of ventricular tachycardia (VT) risk in the setting of ischemia-mediated myocardial fibrosis, as evidenced by recently published clinical case reports. The efficacy of tissue electroporation has been documented in other branches of science and medicine; however, ventricular PFA’s potential advantages and pitfalls are less understood. This comprehensive review will briefly summarize the pathophysiological mechanisms underlying VT and then summarize the pre-clinical and adult clinical data published to date on PFA’s effectiveness in treating monomorphic VT. These data will be contrasted with the effectiveness ascribed to thermal cardiac ablation modalities to treat VT, namely radiofrequency energy and liquid nitrogen-based cryoablation.

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Pulsed field ablation as a precise approach for cardiac arrhythmia treatment via cardiac microenvironment remodeling

Cited by 2 publications

References 28 publications

Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications

Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications

Opportunities and Challenges in Catheter-Based Irreversible Electroporation for Ventricular Tachycardia

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