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Nies M, Watanabe K, Kawamura I, Wang BJ, Litt J, Turovskiy R, Danitz DJ, Uecker DR, Linder KE, Maejima Y, Sasano T, Reddy VY, Koruth JS. Ablating Myocardium Using Nanosecond Pulsed Electric Fields: Preclinical Assessment of Feasibility, Safety and Durability. Circ Arrhythm Electrophysiol 2024. [PMID: 38758741 DOI: 10.1161/circep.124.012854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/17/2024] [Indexed: 05/19/2024]
Abstract
Background:Unlike "conventional" microsecond pulsed electrical fields that primarily target the cell membranes, nanosecond pulses are thought to primarily electroporate intracellular organelles. We conducted a comprehensive preclinical assessment of catheter-based endocardial nanosecond pulsed field ablation (nsPFA) in swine. Methods: A novel endocardial nsPFA system was evaluated in a total of 25 swine. Using either a low-dose (5-second duration) or high-dose (15-second duration) strategy, thoracic veins and discrete atrial and ventricular sites were ablated. Swine were survived for <1 (n=1), ~2 (n=7), ~7 (n=6), 14 (n=2), or ~28 (n=9) days and venous isolation assessed before sacrifice. Safety assessments included evaluation of esophageal effects, phrenic nerve function, and changes in venous caliber. All tissues were subject to careful gross pathological and histopathological examination. Results: All (100%) veins (13 low-dose, 34 high-dose) were acutely isolated, and all reassessed veins (6 low-dose, 15 high-dose) were durably isolated. All examined vein lesions (10 low-dose, 22 high-dose) were transmural. Vein diameters (n=15) were not significantly changed. Of the animals assessed for phrenic palsy (n=9), 3 (33%) demonstrated only transient palsy. There were no differences between dosing strategies. Thirteen mitral isthmus lesions were analyzed and all 13 (100%) were transmural (depth 6.4±0.4mm). Ventricular lesions were 14.7±4.5mm wide and 7.1±1.3mm deep, with high-dose lesions deeper than low-dose (7.9±1.2mm vs 6.2±0.8mm, p=0.007). The esophagus revealed non-transmural adventitial surface lesions in 5 of 5 (100%) animals sacrificed early (2 days) post-ablation. In the 10 animals sacrificed later (14-28 days), all animals demonstrated significant esophageal healing - 8 with complete resolution, and 2 with only trace fibrosis. Conclusions: A novel, endocardial nanosecond PFA system provides acute and durable venous isolation and linear lesions. Transient phrenic injury and non-transmural esophageal lesions can occur with worst case assessments suggesting limits to PFA tissue selectivity and the need for dedicated assessments during clinical studies.
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Affiliation(s)
- Moritz Nies
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY & Department of Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Keita Watanabe
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Iwanari Kawamura
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY & Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Bingyan J Wang
- Cardiovascular Regenerative Medicine, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | | | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan & Department of Cell Biology and Molecular Medicine, Cardiovascular Research Institute, Rutgers-New Jersey Medical School, Newark, NJ
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical & Dental University, Tokyo, Japan
| | - Vivek Y Reddy
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob S Koruth
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY
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Ladejobi A, Christopoulos G, Tan N, Ladas TP, Tri J, van Zyl M, Yasin O, Sugrue A, Khabsa M, Uecker DR, Connolly RJ, Danitz DJ, DeSimone CV, Killu AM, Maor E, Holmes D, Asirvatham SJ, Del-Carpio Munoz F. Effects of Pulsed Electric Fields on the Coronary Arteries in Swine. Circ Arrhythm Electrophysiol 2022; 15:e010668. [PMID: 36194538 DOI: 10.1161/circep.121.010668] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous animal studies have shown no significant vascular injury from pulsed electrical field (PEF) ablation. We sought to assess the effect of PEF on swine coronary arteries. METHODS We performed intracoronary and epicardial (near the coronary artery) PEF ablations in swine pretreated with dual antiplatelet and antiarrhythmic therapy. Intracoronary PEF was delivered using MapiT catheters (Biotronik, Berlin), whereas epicardial PEF was delivered using EPT catheters (Boston Scientific, MA). PEF pulse duration was microseconds (Nanoknife 3.0, Angio Dynamics, NY) or nanoseconds (CellFX, Pulse Biosciences, CA). RESULTS We performed 39 intracoronary ablations in 10 swine and 20 epicardial-pericoronary ablations in 4 separate swine. Intracoronary PEF was delivered at higher energy compared with epicardial PEF (46 [interquartile range, IQR 20-85] J versus 10 [IQR 10-11] J, P < 0.01). Reversible coronary spasm occurred in 49% intracoronary ablations and 45% epicardial ablations (P=0.80). At the end study, fixed coronary stenosis was demonstrated in 44% intracoronary ablations (80% for microsecond PEF and 18% for nanosecond PEF) and 0% epicardial ablations. Visible hemorrhagic and/or fibrotic myocardial lesions were observed at necropsy with similar frequency between intracoronary and epicardial PEF (45% versus 50%, P=0.70). Nanosecond PEF (49 ablations in 11 swine), when compared with microsecond PEF (10 intracoronary ablations in 3 swine), resulted in lower energy delivery (21 [IQR 10-46] J versus 129 [IQR 24-143] J, P=0.03) and less incidence of fixed coronary stenosis (18% versus 80%, P=0.04). CONCLUSIONS In the swine model, intracoronary PEF resulted both in significant coronary spasm and fixed coronary stenosis. Epicardial PEF, delivered at lower energy, resulted in reversible spasm but no fixed coronary stenosis.
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Affiliation(s)
- Adetola Ladejobi
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Georgios Christopoulos
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Nicholas Tan
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Thomas P Ladas
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Jason Tri
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Martin van Zyl
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Omar Yasin
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Alan Sugrue
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Mariam Khabsa
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Darrin R Uecker
- Pulse Biosciences Inc., Hayward, CA (D.R.U., R.J.C., D.J.D.)
| | | | - David J Danitz
- Pulse Biosciences Inc., Hayward, CA (D.R.U., R.J.C., D.J.D.)
| | - Christopher V DeSimone
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (E.M.)
| | - David Holmes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
| | - Freddy Del-Carpio Munoz
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN (A.L., G.C., N.T., T.P.L., J.T., M.V.Z., O.Y., A.S., M.K., C.V.D., A.M.K., D.H., S.J.A., F.D-C.M.)
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