|
|
|
| Application Progress of Pulsed Electric Field Ablation in the Treatment of Atrial Fibrillation |
| Zang Lianru1#, Ji Xingkai1, Zhang Hao1, Yan Shengjie1, Wu Xiaomei1,2,3,4,5#* |
1(Centre for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai 200438, China)
2(Academy for Engineering and Technology, Fudan University, Shanghai 200433, China)
3(Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention (MICCAI) of Shanghai, Fudan University, Shanghai 200032, China)
4(Shanghai Engineering Research Centre of Assistive Devices, Shanghai 200093, China)
5(Yiwu Research Institute of Fudan University, Yiwu 322000, Zhejiang, China) |
|
|
|
|
Abstract Atrial fibrillation (AF) is one of the most common arrhythmias in clinical practice, and pulmonary vein isolation of the left atrium is an effective method for treating atrial fibrillation. Pulsed electric field ablation (PFA) is a new ablation technique that uses high voltage and short duration to injure tissue by an irreversible electroporation mechanism. For the application of PFA in the field of AF treatment, firstly, the principle of PFA was introduced; then results of clinical experiments were used to demonstrate the advantages of PFA, including the non-thermal effect that could not only achieve effective myocardial tissue injury but also reduce the risk of injury to adjacent myocardial tissues (such as pulmonary veins, esophagus, phrenic nerves, blood vessels), fast ablation speed, and low contact dependence. The current mainstream PFA systems, the characteristics of ablation catheters corresponding to these systems, and clinical applications were also introduced. Finally, suggestions for the problems to be solved in the application of PFA in the treatment of AF at present were proposed, and perspectives for the future development of this field were provided.
|
|
Received: 03 March 2022
|
|
|
|
Corresponding Authors:
*E-mail: xiaomeiwu@fudan.edu.cn
|
| About author:: #Member, Chinese Society of Biomedical Engineering |
|
|
|
[1] Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins[J]. N Engl J Med, 1998, 339(10): 659-666.
[2] Muthalaly RG, John RM, Schaeffer B, et al. Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation[J]. J Cardiovasc Electrophysiol, 2018, 29(6): 854-860.
[3] Kowlgi GN, Kapa S. Advances in atrial fibrillation ablation: energy sources here to stay[J]. Card Electrophysiol Clin, 2020, 12(2): 167-174.
[4] Nakagawa H, Jackman WM. Electroporation (revival of direct current ablation): new approach for increasing epicardial ablation safety in close proximity to a coronary artery[J]. Circ Arrhythm Electrophysiol, 2014, 7(5): 779-780.
[5] Blazevski A, Amin A, Scheltema MJ, et al. Focal ablation of apical prostate cancer lesions with irreversible electroporation (IRE)[J]. World J Urol, 2020,39(4): 1107-1114.
[6] 李升平, 何朝滨, 王俊, 等. 开腹手术中超声引导下不可逆电穿孔联合化疗治疗局部进展期胰腺癌64例临床报告[J]. 中华外科杂志, 2020, 58(10): 787-792.
[7] Dai Zihao, Wang Zongren, Lei Kai, et al. Irreversible electroporation induces CD8 + T cell immune response against post-ablation hepatocellular carcinoma growth[J]. Cancer Lett, 2021, 503: 1-10.
[8] Vera-Tizatl CE, Talamás-Rohana P, Vera-Hernández A, et al. Cell morphology impact on the set-up of electroporation protocols for in-suspension and adhered breast cancer cells[J]. Electromagn Biol Med, 2020, 39(4): 323-339.
[9] Verma A, Asivatham SJ, Deneke T, et al. Primer on pulsed electrical field ablation[J]. Circ Arrhythm Electrophysiol, 2021, 14(9): e10086.
[10] Lavee J, Onik G, Mikus P, et al. A novel nonthermal energy source for surgical epicardial atrial ablation: irreversible electroporation[J]. Heart Surg Forum, 2007, 10(2): e162-e167.
[11] Wittkampf FH, van D, van W, et al. Feasibility of electroporation for the creation of pulmonary vein ostial lesions[J]. J Cardiovasc Electrophysiol, 2011, 22(3): 302-309.
[12] Xie Fei, Varghese F, Pakhomov AG, et al. Ablation of myocardial tissue with nanosecond pulsed electric fields[J]. PLoS ONE, 2015, 10(12): e144833.
[13] Reddy VY, Koruth J, Jais P, et al. Ablation of atrial fibrillation with pulsed electric fields[J]. JACC Clin Electrophysiol, 2018, 4(8): 987-995.
[14] van E, Konings MK, Du Pré BC, et al. High-frequency irreversible electroporation for cardiac ablation using an asymmetrical waveform[J]. Biomed Eng Online, 2019, 18(1): 1-13.
[15] Reddy VY, Dukkipati SR, Neuzil P, et al. Pulsed field ablation of paroxysmal atrial fibrillation: one-year outcomes of impulse, pefcat & pefcat Ⅱ[J]. JACC Clin Electrophysiol, 2021, 7(5): 614-627.
[16] Yao Chenguo, Liu Hongmei, Zhao Yajun, et al. Analysis of dynamic processes in single-cell electroporation and their effects on parameter selection based on the finite-element model[J]. IEEE Trans Plasma Sci, 2017, 45(5): 889-900.
[17] Stampfli R. Reversible electrical breakdown of the excitable membrane of a ranvier node[J]. An Acad Brasil Ciens, 1958, 30(1): 57-61.
[18] Wagstaff PG, De B, Van D, et al. Irreversible electroporation of the porcine kidney: temperature development and distribution[J]. Urol Oncol, 2015, 33(4): e1-e7.
[19] Faroja M, Ahmed M, Appelbaum L, et al. Irreversible electroporation ablation: is all the damage nonthermal?[J]. Radiology, 2013, 266(2): 462-470.
[20] Ramirez FD, Reddy VY, Viswanathan R, et al. Emerging technologies for pulmonary vein isolation[J]. Circ Res, 2020, 127(1): 170-183.
[21] Kaminska I, Kotulska M, Stecka A, et al. Electroporation-induced changes in normal immature rat myoblasts (H9C2)[J]. Gen Physiol Biophys, 2012, 31(1): 19-25.
[22] Hunter DW, Kostecki G, Fish JM, et al. In vitro cell selectivity of reversible and irreversible[J]. Circ Arrhythm Electrophysiol, 2021, 14(4): e8817.
[23] Bradley CJ, Haines DE. Pulsed field ablation for pulmonary vein isolation in the treatment of atrial fibrillation[J]. J Cardiovasc Electrophysiol, 2020, 31(8): 2136-2147.
[24] Reddy VY, Neuzil P, Koruth JS, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation[J]. J Am Coll Cardiol, 2019, 74(3): 315-326.
[25] Reddy VY, Anter E, Rackauskas G, et al. Lattice-tip focal ablation catheter that toggles between radiofrequency and pulsed field energy to treat atrial fibrillation: a first-in-human trial[J]. Circ Arrhythm Electrophysiol, 2020, 13(6): e8718.
[26] Yavin H, Shapira-Daniels A, Barkagan M, et al. Pulsed-field ablation using a lattice electrode for focal energy delivery: biophysical characterization, lesion durability and safety evaluation[J]. Circ Arrhythm Electrophysiol, 2020, 13(6): e8580.
[27] Stewart MT, Haines DE, Verma A, et al. Intracardiac pulsed field ablation: proof of feasibility in a chronic porcine model[J]. Heart Rhythm, 2018, 16(5): 754-764.
[28] Stewart MT, Haines DE, Miklavi D, et al. Safety and chronic lesion characterization of pulsed field ablation in a porcine model[J]. J Cardiovasc Electrophysiol, 2021, 32(4): 958-969.
[29] Nakatani Y, Sridi-Cheniti S, Cheniti G, et al. Pulsed field ablation prevents chronic atrial fibrotic changes and restrictive mechanics after catheter ablation for atrial fibrillation[J]. EP Europace, 2021, 23(11): 1767-1776.
[30] Howard B, Haines DE, Verma A, et al. Reduction in pulmonary vein stenosis and collateral damage with pulsed field ablation compared with radiofrequency ablation in a canine model[J]. Circ Arrhythm Electrophysiol, 2020, 13(9): e8337.
[31] Cochet H, Nakatani Y, Sridi-Cheniti S, et al. Pulsed field ablation selectively spares the oesophagus during pulmonary vein isolation for atrial fibrillation[J]. EP Europace, 2021, 23(9): 1391-1399.
[32] Wittkampf FHM, René VE, Neven K. Electroporation and its relevance for cardiac catheter ablation[J]. JACC Clin Electrophysiol, 2018, 4(8): 977-986.
[33] Van D, Neven K, Van WH, et al. Low vulnerability of the right phrenic nerve to electroporation ablation[J]. Heart Rhythm, 2015, 12(8): 1838-1844.
[34] Neven K, Driel VV, Wessel HV, et al. Epicardial linear electroporation ablation and lesion size[J]. Heart Rhythm, 2014, 11(8): 1465-1470.
[35] du Pré BC, Van D, Van WH, et al. Minimal coronary artery damage by myocardial electroporation ablation[J]. Europace, 2012, 15(1): 144-149.
[36] Maor E, Ivorra A, Leor J, et al. The effect of irreversible electroporation on blood vessels[J]. Technol Cancer Res Treat, 2007, 6(4): 307-312.
[37] Koruth JS, Kuroki K, Kawamura I, et al. Pulsed field ablation vs radiofrequency ablation: esophageal injury in a novel porcine model[J]. Circ Arrhythm Electrophysiol, 2020, 13(3): e8303.
[38] Kuroki K, Whang W, Eggert C, et al. Ostial dimensional changes after pulmonary vein isolation: pulsed field ablation vs radiofrequency ablation[J]. Heart Rhythm, 2020, 17(9): 1528-1535.
[39] Husaini M, Quader N, Braverman A, et al. Massive left atrial thrombus after a left atrial surgical ablation and bioprosthetic mitral valve replacement[J]. Innovations (Phila), 2020, 15(4): 389-392.
[40] Maor E, Sugrue A, Witt C, et al. Pulsed electric fields for cardiac ablation and beyond: a state-of-the-art review[J]. Heart Rhythm, 2019, 16(7): 1112-1120.
[41] Di MA, Vitulano N, Troisi F, et al. Pulsed field ablation to treat atrial fibrillation: a review of the literature[J]. J Cardiovasc Dev Dis, 2022, 9(4): 94.
[42] Dermol-Černe J, Batista N, Reberšek M, et al. Short microsecond pulses achieve homogeneous electroporation of elongated biological cells irrespective of their orientation in electric field[J]. Sci Rep, 2020, 10(1): 1-17.
[43] Reddy Vy, Anic A, Koruth J, et al. Pulsed field ablation in patients with persistent atrial fibrillation[J]. J Am Coll Cardiol, 2020, 76(9): 1068-1080.
[44] 唐闽, 牛国栋, 郭金锐, 等. 新型脉冲电场消融系统治疗阵发性心房颤动3例[J]. 中华心律失常学杂志, 2022, 26(1): 96-98.
[45] 储慧民, 张劲林, 王祖禄, 等. 国产脉冲消融系统治疗阵发性心房颤动的可行性和安全性[J]. 中华心律失常学杂志, 2022, 26(1): 91-95.
[46] Anter E, Neuil P, Rackauskas G, et al. A lattice-tip temperature-controlled radiofrequency ablation catheter for wide thermal lesions: first-in-human experience with atrial fibrillation[J]. JACC Clin Electrophysiol, 2020, 6(5): 507-519.
[47] Koruth JS, Kuroki K, Kawamura I, et al. Focal pulsed field ablation for pulmonary vein isolation and linear atrial lesions[J]. Circ Arrhythm Electrophysiol, 2020, 13(6): e8716.
[48] Zhu Tongjian, Wang Zhen, Wang Songyun, et al. Pulsed field ablation of superior vena cava: feasibility and safety of pulsed field ablation[J]. Front Cardiovasc, 2021, 8: 698716.
[49] 余锂镭, 王松云, 袁晓玲, 等. 脉冲电场消融治疗阵发性心房颤动的初步临床应用[J]. 中国心脏起搏与心电生理杂志, 2021, 35(5): 434-438.
[50] Rdharma. Medtronic gets FDA approval for pulseselect PFA system trial to treat AF[EB/OL]. https://www.nsmedicaldevices.com/news/medtronic-pulseselect-pfa, 2020-01-24/2022-1-18.
[51] ClinicalTrials. Pulsed field ablation to irreversibly electroporate tissue and treat AF (PULSED AF)[EB/OL]. https://clinicaltrials.gov/ct2/show/study/NCT04198701, 2021-12-22/2022-2-1.
[52] Medtronic. PVAC GOLD[EB/OL]. https://europe.medtronic.com/xd-en/healthcare-professionals/products/cardiac-rhythm/ablation-atrial-fibrillation/pulmonary-vein-ablation-catheter-gold.html, 2021-10-01/2022-02-15.
[53] Barkagan M, Leshem E, Rottmann M, et al. Expandable lattice electrode ablation catheter[J]. Circ Arrhythm Electrophysiol, 2019, 12(4): e7090.
[54] Koruth J, Kuroki K, Iwasawa J, et al. Preclinical evaluation of pulsed field ablation[J]. Circ Arrhythm Electrophysiol, 2019, 12(12): e7781.
[55] Belalcazar A. Safety and efficacy aspects of pulsed field ablation catheters as a function of electrode proximity to blood and energy delivery method[J]. Heart Rhythm, 2021,2(6):560-569.
[56] Groen MHA, van E, van K, et al. In vivo analysis of the origin and characteristics of gaseous microemboli during catheter-mediated irreversible electroporation[J]. EP Europace, 2021, 23(1): 139-146.
[57] Caluori G, Odehnalova E, Jadczyk T, et al. AC Pulsed field ablation is feasible and safe in atrial and ventricular settings: a proof-of-concept chronic animal study[J]. Front Bioeng Biotechnol, 2020, 8(8): 1-15.
[58] Van E, Konings MK, Du Pré BC, et al. High-frequency irreversible electroporation for cardiac ablation using an asymmetrical waveform[J]. Biomed Eng Online, 2019, 18(1): 75.
[59] 姚陈果. 新型复合脉冲不可逆电穿孔治疗肿瘤关键技术及临床应用研究进展[J]. 高电压技术, 2018, 44(1): 248-263.
[60] Aycock KN, Zhao Yajun, Lorenzo MF, et al. A Theoretical argument for extended interpulse delays in therapeutic high-frequency irreversible electroporation treatments[J]. IEEE Trans Biomed Eng, 2021, 68(6): 1999-2010.
[61] 王宪颖, 邬晓臣, 柯振武, 等. 2D延迟增强磁共振成像预测外科治疗房颤转复疗效临床研究[J]. 中国体外循环杂志, 2020, 18(2): 113-117.
[62] Boyle PM, Zghaib T, Zahid S, et al. Computationally guided personalized targeted ablation of persistent atrial fibrillation[J]. Nat Biomed Eng, 2019, 3(11): 870-879. |
|
|
|
