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Chang R, Luo D, He W, Tang W, Chen J, Li J, Liu M, Zhang X, Chen X, Su C, Jiang J, Long M, Wang L. A novel method for septal reduction therapy by three-dimensional guided transvenous intraseptal pulsed-field ablation. Heart Rhythm 2024; 21:258-267. [PMID: 38008368 DOI: 10.1016/j.hrthm.2023.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Pulsed-field ablation (PFA) is a nonthermal method for achieving selective cell death with little inflammation response. However, there are no reports of PFA for septal reduction therapy (SRT). OBJECTIVE The purpose of this study was to investigate the effectiveness and safety of PFA for SRT. METHODS A novel transvenous intraseptal PFA method with 3-dimensional (3D) guidance was introduced in Yorkshire pigs. Electrocardiographic parameters, transthoracic echocardiography, and histopathology were used to evaluated. RESULTS The maximum injury diameter of intramyocardial PFA increased with electric field intensity. After PFA, bipolar electrogram amplitude and pacing threshold measured by the PFA electrodes significantly decreased (F = 6.945, P = .007) or increased (F = 5.842, P = .024), respectively. In the ablated septal region, motion amplitude and systolic wall thickening rate significantly decreased and remained at low levels (motion amplitude: F = 20.793, P = .000; systolic wall thickening rate: F = 14.343, P = .000); however, septal thickness did not significantly change after PFA (F = 1.503, P = .248). Histologic examination showed specific cardiomyocyte death with gradually increased hyperchromatic cytoplasm and nuclear pyknosis, without obvious inflammatory cell infiltration in acute phase. TUNEL stain for fragmented DNA showed extensively positive in the ablation region 24 hours after PFA. During PFA, no sustained ventricular arrhythmia or atrioventricular conduction block occurred. CONCLUSION A novel intraseptal PFA method with 3D guidance was described. Intraseptal PFA resulted in effective myocardial injury and local hypokinesis without significant acute edema. Histologic examination showed widely programmed cardiomyocyte death with little inflammatory cell infiltration.
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Affiliation(s)
- Rongxuan Chang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Duan Luo
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Wei He
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wei Tang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Jian Chen
- Department of Cardiac Surgery, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jie Li
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Xiaoyu Zhang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Xumiao Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Chen Su
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Jingzhou Jiang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China
| | - Ming Long
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China.
| | - Lichun Wang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Key Laboratory on Assisted Circulation, Guangzhou, Guangdong, China.
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