Pulsed field ablation prevents chronic atrial fibrotic changes and restrictive mechanics after catheter ablation for atrial fibrillation

Nakatani, Yosuke; Sridi‐Cheniti, Soumaya; Cheniti, Ghassen; Ramirez, F. Daniel; Goujeau, Cyril; André, Clémentine; Nakashima, Takashi; Eggert, Charles A.; Schneider, Christopher; Viswanathan, Raju; Krisai, Philipp; Takagi, Takamitsu; Kamakura, Tsukasa; Vlachos, Konstantinos; Derval, Nicolas; Duchâteau, Josselin; Pambrun, Thomas; Chauvel, Rémi; Reddy, Vivek Y.; Montaudon, Michel; Laurent, François; Sacher, Frédéric; Hocini, Mélèze; Haı̈ssaguerre, Michel; Jaı̈s, Pierre; Cochet, Hubert

doi:10.1093/europace/euab155

Cited by 70 publications

(84 citation statements)

References 21 publications

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“…PEF ablation has brought about a change in the ablation catheter and ablation concept and is expected to be a new source of energy for arrhythmia ablation therapy, and the current findings suggest that this is a highly promising direction for clinical application ( 8 ). PEF ablation creates a larger and more homogeneous range of acute injury, which is beneficial in preventing decreased atrial/ventricular muscle compliance and in preserving atrial reserve and ejection function ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

Study of necrotic apoptosis by pulsed electric field ablation in rabbit left ventricular myocardium

Zhao

Chen²,

Wu³

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveWe investigate the characteristics of histological damage to myocardial cells in the ablation region and surrounding areas of the left ventricular epicardium in rabbits using our self-developed cardiac pulsed electric field (PEF) ablation instrument and ablation catheter.MethodsForty eight New Zealand rabbits underwent ablation on the left ventricular myocardium after open-heart exposure with a cardiac arrhythmia PEF ablation device and ablation catheter developed by the Medical Translation Laboratory of Pulsed Electric Field Technology in Zhejiang Province. The ablation parameters were set as biphasic electrical pulses; voltage, ±800 V; pulse width, 10 μs; interphase delay, 500 us. Six rabbits were included in the sham group and 42 other rabbits were randomly divided into immediately, 6-h, 1-, 3-day, 1-, 2-, and 4-week post-ablation groups, with six rabbits in each group. Creatine kinase- (CK)-MB isoenzyme (CK-MB), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels were measured before and at different time points after PEF ablation to analyze their dynamic evolution. Masson staining of tissue block sections of left ventricular myocardial ablation and adjacent tissue heart specimens was performed, and the occurrence of TUNEL apoptosis in myocardium tissue was analyzed.ResultsAll rabbits completed the PEF ablation procedure and the follow-up process. After PEF ablation, the levels of cardiac enzymes, including CK-MB, CK, and AST, increased significantly, peaking 1–3 days after the procedure. In particular, those of CK and CK-MB increased by 15–20 times but returned to the preoperative level after 2 weeks. Based on general observation, it was found that the myocardium in the ablation area was swollen immediately after PEF ablation. Masson staining analysis revealed that cardiomyocytes were broken and infiltrated by erythrocytes after 6 h. After 1 day, the cells started to experience atrophy and necrosis; after 3 days, fibrotic replacement of the necrotic area became obvious. Then, by 4 weeks, the myocardial cells were completely replaced by hyperplasia. Apoptosis occurred significantly at 6 h and peaked at 24 h post-ablation, demonstrating a 37.7-fold increase; apoptotic cell counts decreased significantly at 3 days post-ablation, and no significant apoptotic cardiomyocytes were seen after 1 week.ConclusionAfter PEF ablation, cardiomyocytes showed apoptotic process and dyed, at least partially, through a secondary necrosis, the ablation boundary was clear, the ablation area was replaced by structurally intact fibroblasts, no island myocardium tissue were seen, and the ablation area vessels and nerves were not affected.

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Section: Discussionmentioning

confidence: 99%

Study of necrotic apoptosis by pulsed electric field ablation in rabbit left ventricular myocardium

Zhao

Chen²,

Wu³

et al. 2022

Front. Cardiovasc. Med.

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“…Nakatani et al recently showed that, compared to thermal ablation (radiofrequency or cryoablation), pulsed field ablation was associated with similar decreases in LA reservoir and booster pump functions and larger late gadolinium enhancement volume at cardiac magnetic resonance in the acute phase (<3 hours after ablation), while recovery of LA mechanical function and disappearance of the majority of late gadolinium enhancement in the chronic stage (3 months after ablation) was observed. [ 82 ] Of note, both alterations persisted in the chronic stage following thermal ablation. These findings suggest that tissue repair following pulsed field ablation involves less chronic fibrosis compared to thermal ablation, therefore resulting in better preservation of LA mechanical function.…”

Section: Catheter Ablation Of Af In Hfpefmentioning

confidence: 99%

Safety, Efficacy and Prognostic Benefit of Atrial Fibrillation Ablation in Heart Failure with Preserved Ejection Fraction

Johner

Namdar

Shah

2022

Arrhythm Electrophysiol Rev

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Up to 65% of patients with heart failure with preserved ejection fraction (HFpEF) develop AF during the course of the disease. This occurrence is associated with adverse outcomes, including pump failure death. Because AF and HFpEF are mutually reinforcing risk factors, sinus rhythm restoration may represent a disease-modifying intervention. While catheter ablation exhibits acceptable safety and efficacy profiles, no randomised trials have compared AF ablation with medical management in HFpEF. However, catheter ablation has been reported to result in lower natriuretic peptides, lower filling pressures, greater peak cardiac output and improved functional capacity in HFpEF. There is growing evidence that catheter ablation may reduce HFpEF severity, hospitalisation and mortality compared to medical management. Based on indirect evidence, early catheter ablation and minimally extensive atrial injury should be favoured. Hence, individualised ablation strategies stratified by stepwise substrate inducibility provide a logical basis for catheter-based rhythm control in this heterogenous population. Randomised trials are needed for definitive evidence-based guidelines.

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“…Moreover, since cardiomyocytes have low sensitivity to PFA, a minimal risk of collateral damage is present. As shown in a recent imaging study, PFA results in an increased late gadolinium enhancement without injuring the microvasculature or inducing intramural hemorrhage, whereas the chronic fibrotic changes are of a lesser magnitude compared to thermal ablation techniques [ 89 ]. Additionally, the lack of coagulative necrosis with PFA suggests a minimal risk of incident pulmonary vein stenosis, as demonstrated by Kuroki et al [ 90 ].…”

Section: Atrial Fibrillation Catheter Ablationmentioning

confidence: 99%

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

Theofilis

Oikonomou²,

Antonopoulos³

et al. 2022

Biomedicines

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Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, represents a major cause of morbidity and mortality, with an increasing prevalence. Pharmacologic treatment remains the cornerstone of its management through rhythm and rate control, as well as the prevention of thromboembolism with the use of oral anticoagulants. Recent progress in percutaneous interventional approaches have provided additional options in the therapeutic arsenal, however. The use of the different catheter ablation techniques can now lead to long arrhythmia-free intervals and significantly lower AF burden, thus reducing the rate of its complications. Particularly encouraging evidence is now available for patients with persistent AF or concomitant heart failure, situations in which catheter ablation could even be a first-line option. In the field of stroke prevention, targeting the left atrial appendage with percutaneous device implantation may reduce the risk of thromboembolism to lower rates than that predicted with conventional ischemic risk scores. Left atrial appendage occlusion through the approved Watchman or Amplatzer devices is a well-established, efficacious, and safe method, especially in high-ischemic and bleeding risk patients with contraindications for oral anticoagulation.

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Pulsed field ablation prevents chronic atrial fibrotic changes and restrictive mechanics after catheter ablation for atrial fibrillation

Cited by 70 publications

References 21 publications

Study of necrotic apoptosis by pulsed electric field ablation in rabbit left ventricular myocardium

Study of necrotic apoptosis by pulsed electric field ablation in rabbit left ventricular myocardium

Safety, Efficacy and Prognostic Benefit of Atrial Fibrillation Ablation in Heart Failure with Preserved Ejection Fraction

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

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