Title |
Ablation of Atrial Fibrillation With Pulsed Electric Fields An Ultra-Rapid, Tissue-Selective Modality for Cardiac Ablation
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Published in |
JACC: Clinical Electrophysiology, May 2018
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DOI | 10.1016/j.jacep.2018.04.005 |
Pubmed ID | |
Authors |
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 |
Abstract |
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. 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. 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. 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. These data usher in a new era of tissue-specific, ultrarapid ablation of atrial fibrillation. |
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Country | Count | As % |
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United States | 24 | 35% |
Turkey | 7 | 10% |
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Australia | 3 | 4% |
Ireland | 1 | 1% |
Brazil | 1 | 1% |
Russia | 1 | 1% |
Uruguay | 1 | 1% |
Netherlands | 1 | 1% |
Other | 6 | 9% |
Unknown | 19 | 28% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 38 | 56% |
Practitioners (doctors, other healthcare professionals) | 14 | 21% |
Scientists | 12 | 18% |
Science communicators (journalists, bloggers, editors) | 4 | 6% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 149 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Researcher | 24 | 16% |
Other | 21 | 14% |
Student > Ph. D. Student | 14 | 9% |
Student > Master | 12 | 8% |
Student > Bachelor | 10 | 7% |
Other | 23 | 15% |
Unknown | 45 | 30% |
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Engineering | 14 | 9% |
Agricultural and Biological Sciences | 9 | 6% |
Biochemistry, Genetics and Molecular Biology | 4 | 3% |
Unspecified | 3 | 2% |
Other | 5 | 3% |
Unknown | 57 | 38% |