Preclinical Study of Pulsed Field Ablation of Difficult Ventricular Targets: Intracavitary Mobile Structures, Interventricular Septum, and Left Ventricular Free Wall.

IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Moritz Nies, Keita Watanabe, Iwanari Kawamura, Carlos G Santos-Gallego, Vivek Y Reddy, Jacob S Koruth
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引用次数: 0

Abstract

Background: Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA's ability to target intracavitary structures, epicardium, and ways to achieve transmural lesions across thick ventricular tissue.

Methods: A lattice-tip catheter was used to deliver biphasic monopolar PFA to swine ventricles under general anesthesia, with electroanatomical mapping, fluoroscopy and intracardiac echocardiography guidance. We conducted experiments to assess the feasibility and safety of repetitive monopolar PFA applications to ablate (1) intracavitary papillary muscles and moderator bands, (2) epicardial targets, and (3) bipolar PFA for midmyocardial targets in the interventricular septum and left ventricular free wall.

Results: (1) Papillary muscles (n=13) were successfully ablated and then evaluated at 2, 7, and 21 days. Nine lesions with stable contact measured 18.3±2.4 mm long, 15.3±1.5 mm wide, and 5.8±1.0 mm deep at 2 days. Chronic lesions demonstrated preserved chordae without mitral regurgitation. Two targeted moderator bands were transmurally ablated without structural disruption. (2) Transatrial saline/carbon dioxide assisted epicardial access was obtained successfully and epicardial monopolar lesions had a mean length, width, and depth of 30.4±4.2, 23.5±4.1, and 9.1±1.9 mm, respectively. (3) Bipolar PFA lesions were delivered across the septum (n=11) and the left ventricular free wall (n=7). Twelve completed bipolar lesions had a mean length, width, and depth of 29.6±5.5, 21.0±7.3, and 14.3±4.7 mm, respectively. Chronically, these lesions demonstrated uniform fibrotic changes without tissue disruption. Bipolar lesions were significantly deeper than the monopolar epicardial lesions.

Conclusions: This in vivo evaluation demonstrates that PFA can successfully ablate intracavitary structures and create deep epicardial lesions and transmural left ventricular lesions.

脉冲场消融 "困难 "心室靶点的临床前研究:腔内移动结构、室间隔和左室游离壁。
背景:- 基于心内膜导管的心室心肌脉冲场消融术(PFA)前景广阔。然而,人们对 PFA 针对腔内结构、心外膜的能力以及在厚心室组织中实现跨膜病变的方法知之甚少。方法:- 在全身麻醉、电解剖图、透视和心内超声心动图(ICE)引导下,使用格状尖端导管将双相单极 PFA 输送到猪心室。我们进行了实验,以评估重复应用单极 PFA 消融以下目标的可行性和安全性:i)腔内乳头肌和节律带;ii)心外膜目标;iii)用于室间隔和左心室游离壁的心肌中层目标的双极 PFA。结果如下- i) 成功消融了乳头肌(n=13),然后在 2、7 和 21 天进行了评估。九个接触稳定的病灶在 2 天时的长度为 18.3≥2.4毫米,宽度为 15.3≥1.5毫米,深度为 5.8≥1.0毫米。慢性病损显示腱膜保留,无二尖瓣反流。ii) 经心房生理盐水/二氧化碳辅助心外膜入路成功,心外膜单极病变的平均长度、宽度和深度分别为 30.4≥4.2 毫米、23.5≥4.1 毫米和 9.1≥1.9 毫米。12 个完成的双极病变的平均长度、宽度和深度分别为 29.6≥5.5毫米、21.0≥7.3 毫米和 14.3≥4.7毫米。长期来看,这些病变显示出均匀的纤维化变化,但没有组织破坏。双极病变明显深于单极心外膜病变。结论- 这项活体评估表明,PFA 能成功消融腔内结构,形成深心外膜病变和跨壁左心室病变。
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来源期刊
CiteScore
13.70
自引率
4.80%
发文量
187
审稿时长
4-8 weeks
期刊介绍: Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.
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