Ablation of Atrial Fibrillation With Pulsed Electric Fields: An Ultra-Rapid, Tissue-Selective Modality for Cardiac Ablation

Vivek Y. Reddy; Jacob Koruth; Pierre Jais; Jan Petru; Ferdinand Timko; Ivo Skalsky; Robert Hebeler; Louis Labrousse; Laurent Barandon; Stepan Kralovec; Moritoshi Funosako; Boochi Babu Mannuva; Lucie Sediva; Petr Neuzil

doi:10.1016/j.jacep.2018.04.005

JACC: Clinical Electrophysiology

May 2018 DOI: 10.1016/j.jacep.2018.04.005

Ablation of Atrial Fibrillation With Pulsed Electric Fields
An Ultra-Rapid, Tissue-Selective Modality for Cardiac Ablation

Vivek Y. Reddy, Jacob Koruth, Pierre Jais, Jan Petru, Ferdinand Timko, Ivo Skalsky, Robert Hebeler, Louis Labrousse, Laurent Barandon, Stepan Kralovec, Moritoshi Funosako, Boochi Babu Mannuva, Lucie Sediva and Petr Neuzil

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Author + information

DOI:

https://doi.org/10.1016/j.jacep.2018.04.005

Published By:

JACC: Clinical Electrophysiology

Print ISSN:

2405-5018

Online ISSN:

2405-500X

History:

Received April 24, 2018
Accepted April 26, 2018
Published online May 11, 2018.

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2018 American College of Cardiology Foundation

Author Information

Vivek Y. Reddy, MD^a,^b,^∗ (vivek.reddy{at}mountsinai.org),
Jacob Koruth, MD^a,
Pierre Jais, MD^c,
Jan Petru, MD^b,
Ferdinand Timko, MD^d,
Ivo Skalsky, MD^d,
Robert Hebeler, MD^e,
Louis Labrousse, MD^f,
Laurent Barandon, MD^f,
Stepan Kralovec^b,
Moritoshi Funosako, MD^b,
Boochi Babu Mannuva, MD^b,
Lucie Sediva, MD^b and
Petr Neuzil, MD, PhD^b

^aDepartment of Electrophysiology, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
^bDepartment of Cardiology, Homolka Hospital, Prague, Czech Republic
^cDepartment of Cardiology, Division of Electrophysiology, IHU LIRYC ANR-10-IAHU-04, University of Bordeaux, CHU Bordeaux, Bordeaux, France
^dDepartment of Cardiac Surgery, Homolka Hospital, Prague, Czech Republic
^eDepartment of Cardiothoracic Surgery, Baylor Medical Center, Dallas, Texas
^fMedico-Surgical Service of Valvulopathies and Cardiomyopathies - Adult Cardiac Surgery, IHU LIRYC ANR-10-1AHU-04, University of Bordeaux, CHU Bordeaux, Bordeaux, France

↵∗Address for correspondence:
Dr. Vivek Y. Reddy, Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, P.O. Box 1030, New York, New York 10029.

Graphical abstract

Abstract

Background Standard energy sources rely on time-dependent conductive heating/cooling and ablate all tissue types indiscriminately. Pulsed electric field (PEF) energy ablates nonthermally by creating nanoscale pores in cell membranes. Potential advantages for atrial fibrillation ablation include: 1) cardiomyocytes have among the lowest sensitivity of any tissue to PEF—allowing tissue selectivity, thereby minimizing ablation of nontarget collateral tissue; 2) PEF is delivered rapidly over a few seconds; and 3) the absence of coagulative necrosis obviates the risk of pulmonary vein (PV) stenosis.

Objectives The authors report the first acute clinical experience of atrial fibrillation ablation with PEF—both epicardial box lesions during cardiac surgery, and catheter-based PV isolation.

Methods PEF ablation was performed using a custom over-the-wire endocardial catheter for percutaneous transseptal PV isolation, and a linear catheter for encircling the PVs and posterior left atrium during concomitant cardiac surgery. Endocardial voltage maps were created pre and post ablation. Continuous and categorical data are summarized and presented as mean ± SD and frequencies.

Results At 2 centers, 22 patients underwent ablation under general anesthesia: 15 endocardial and 7 epicardial. Catheter PV isolation was successful in all 57 PVs in 15 patients (100%) using 3.26 ± 0.5 lesions/PV: procedure time 67 ± 10.5 min, catheter time (PEF catheter entry to exit) 19 ± 2.5 min, total PEF energy delivery time <60 s/patient, and fluoroscopy time 12 ± 4.0 min. Surgical box lesions were successful in 6 of 7 patients (86%) using 2 lesions/patient. The catheter time for epicardial ablation was 50.7 ± 19.5 min. There were no complications.

Conclusions These data usher in a new era of tissue-specific, ultrarapid ablation of atrial fibrillation.

Key Words

Footnotes

These clinical trials were supported by the manufacturer of the ablation catheters, Iowa Approach Inc. Drs. Reddy and Jais have served as a consultant for Biosense Webster, Boston Scientific, and Iowa Approach; have received grant support from Biosense Webster and Boston Scientific; and have stock options in Iowa Approach. Dr. Koruth has served as a consultant for Biosense Webster and Iowa Approach. Drs. Petru, Kralovec, Sediva, and Neuzil were supported by a scientific grant from the Ministry of Health, Czech Republic (NHH 00023884). Dr. Hebeler has served as a consultant for and has stock options in Iowa Approach. Dr. Neuzil has served as a consultant for and received grant support from Biosense Webster and Boston Scientific; and has received scientific grant support from Iowa Approach. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.

Received April 24, 2018.
Accepted April 26, 2018.

2018 American College of Cardiology Foundation

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