Study on Optimal Parameter and Target for Pulsed-Field Ablation of Atrial Fibrillation

Ye, Xuying; Liu, Shangzhong; Yin, Huiyong; He, Qiang; Xue, Zhixiao; Lu, Chengzhi; Su, Siying

doi:10.3389/fcvm.2021.690092

Cited by 23 publications

(23 citation statements)

References 21 publications

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“…There was no thromboembolism, intracardiac injury, or acute or chronic collateral tissue injury after ablation. Consistent with our previous in vitro experiments ( 18 ), the present results further proved that the biphasic asymmetric pulse mode and PFA system used in the present study had good safety and produced effective lesions. In dog group, the immediately post-op ablation zones showed a low potential and a ring shape.…”

Section: Discussionsupporting

confidence: 93%

“…The mode of ablation in ( 11 ) was biphasic and symmetric. The difference between our experiment and previous PFA studies is the introduction of a new biphasic asymmetric pulse ablation mode, which narrows the width of the negative pulse and reduces the contractions of the muscle caused by the positive pulse ( 18 ). So before the clinical experiments, pigs were used to evaluate the safety and efficacy of biphasic asymmetric pulse ablation mode.…”

Section: Discussionmentioning

confidence: 74%

“…The biphasic asymmetric pulse can reduce muscle contraction compared to monophasic pulses, and has the advantage of lower cell ablation threshold compared to biphasic symmetric pulses. We also updated the catheter used in previous experiments ( 18 ), and added positioning electrodes to the new catheter to ensure that the current state of electrodes was displayed under X-ray to provide more reliable information to doctors. Furthermore, we reinforced the framework of electrodes to make them more rigid and increase the stability of the electrode structure.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Sano et al ( 17 ) found that the lethal threshold of a biphasic symmetric pulse was 1,316 V/cm, which was significantly higher than that of a biphasic asymmetric pulse (536 V/cm). Our previous study on smooth muscle cells and cardiomyocytes found that asymmetric pulse width was superior to biphasic symmetric pulse ablation under equal amplitudes ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

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Preclinical Study of Biphasic Asymmetric Pulsed Field Ablation

Jia

et al. 2022

Front. Cardiovasc. Med.

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Pulsed field ablation (PFA) is a novel method of pulmonary venous isolation in atrial fibrillation ablation and is featured by tissue-selective ablation. Isolation is achieved via the application of high-voltage microsecond pulses that create irreversible perforations in cell membranes (i.e., electroporation). We proposed a new biphasic asymmetric pulse mode and verified the lesion persistence and safety of this mode for pulmonary vein ostia ablation in preclinical studies. We found that biphasic asymmetric pulses can effectively reduce muscle contractions and drop ablation threshold. In the electroanatomic mapping, the ablation site showed a continuous low potential area, and the atrium was not captured after 30 days of pacing. Pathological staining showed that cardiomyocytes in the ablation area were replaced by fibroblasts and there was no damage outside the ablation zone. Our results show that pulmonary venous isolation using the biphasic asymmetric discharge mode is safe, durable, effective, and causes no damage to other tissues.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preclinical Study of Biphasic Asymmetric Pulsed Field Ablation

Jia

et al. 2022

Front. Cardiovasc. Med.

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“…Recently, a domestic Chinese PEF ablation system for paroxysmal AF ablation was reported ( 4 ). The process and evolution of myocardial tissue death by irreversible electroporation have not yet been detailed ( 5 ). In this study, a novel PEF ablation system was developed based on the medical–industrial combination of the previous multidisciplinary frontier crossover innovation team, and, using this instrument, PEF ablation was performed in rabbit hearts.…”

Section: Introductionmentioning

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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