Our Summary

This research paper is about a method of tissue removal called irreversible electroporation, which may be a safe and effective alternative to other techniques that use heat, such as radiofrequency or cryoablation. Electroporation involves using electric currents to create tiny holes in cells, which can lead to their death and removal. The strength of the current, rather than the power, energy, or voltage, is the key factor here. This method can be applied in various ways, such as with a steady or alternating current, or a pulsed current. Experiments have shown that this method is selective, only affecting targeted tissues while leaving arteries and nerves intact. In particular, tests on pigs suggest that applying electroporation inside a pulmonary vein (a vein that carries oxygenated blood from the lungs to the heart) does not cause it to narrow, and that the esophagus (the tube that connects the throat to the stomach) is surprisingly resistant to this method. Therefore, irreversible electroporation shows great promise as a technique for cardiac catheter ablation (a procedure to treat abnormal heart rhythms), especially for isolating the pulmonary vein electrically.

FAQs

  1. What is irreversible electroporation and how is it used in cardiac catheter ablation?
  2. How does irreversible electroporation compare to thermal ablation techniques like radiofrequency or cryoablation?
  3. What are the benefits of using irreversible electroporation for cardiac catheter ablation and electrical pulmonary vein isolation?

Doctor’s Tip

A doctor might tell a patient about cardiac ablation that it is a safe and effective alternative for treating conditions such as atrial fibrillation. They may explain that irreversible electroporation is a nonthermal energy source that can be used during the procedure. It is important for patients to understand that total applied current is the key parameter that causes tissue ablation, and that electroporation can be achieved with various modalities. The doctor may also mention that studies have shown tissue specificity with survival of important structures like arteries and nerves, and that electroporation is a promising technique for cardiac catheter ablation.

Suitable For

Patients with certain types of arrhythmias, such as atrial fibrillation, atrial flutter, supraventricular tachycardia, and ventricular tachycardia, are typically recommended for cardiac ablation. These patients may have symptoms such as palpitations, dizziness, chest pain, or shortness of breath that are not well controlled with medications. They may also have a history of unsuccessful ablation procedures using other techniques, such as radiofrequency or cryoablation. Patients who are not good candidates for traditional ablation techniques due to factors such as anatomy, previous surgeries, or coexisting medical conditions may also be recommended for cardiac ablation using irreversible electroporation.

Timeline

Before cardiac ablation:

  1. Patient is diagnosed with a cardiac arrhythmia, such as atrial fibrillation.
  2. Patient may undergo various tests and evaluations to determine the best course of treatment, including medications and lifestyle changes.
  3. If medications are ineffective or not tolerated, patient may be referred for cardiac ablation.
  4. Patient meets with a cardiologist to discuss the procedure, risks, benefits, and alternatives.
  5. Patient may undergo additional testing, such as imaging studies, to further evaluate the heart’s structure and function.

After cardiac ablation:

  1. Patient undergoes the cardiac ablation procedure, which typically involves the insertion of catheters into the heart through blood vessels in the groin or neck.
  2. During the procedure, the cardiologist uses different energy sources, such as radiofrequency or cryoablation, to create lesions in the heart tissue and disrupt the abnormal electrical signals causing the arrhythmia.
  3. After the procedure, the patient is monitored for a period of time in the hospital to ensure there are no complications.
  4. Patient may experience some discomfort or soreness at the catheter insertion site.
  5. Patient is discharged from the hospital and instructed on post-procedure care, including medication management and follow-up appointments.
  6. Patient may experience improvements in symptoms related to the arrhythmia, such as palpitations or fatigue.
  7. Patient may need to undergo additional testing, such as electrocardiograms, to assess the success of the ablation procedure.

What to Ask Your Doctor

  1. How does cardiac ablation by irreversible electroporation compare to other thermal ablation techniques like radiofrequency or cryoablation in terms of safety and effectiveness?

  2. What is the total applied current and how does it relate to the local voltage gradient that causes electroporation?

  3. What are the different modalities of electroporation that can be used for cardiac ablation?

  4. Have there been any studies on tissue specificity with survival of arteries and nerves in large lesions during cardiac ablation by electroporation?

  5. Is there a risk of pulmonary vein stenosis or damage to the esophagus with irreversible electroporation for cardiac ablation?

  6. What are the potential risks and complications associated with cardiac ablation by irreversible electroporation?

  7. What is the success rate of cardiac ablation by electroporation in treating conditions like atrial fibrillation?

  8. How long does it typically take to recover from a cardiac ablation procedure using irreversible electroporation?

  9. Are there any lifestyle changes or precautions that need to be taken after undergoing cardiac ablation by electroporation?

  10. How often will follow-up appointments be needed after the procedure to monitor the effectiveness of the ablation?

Reference

Authors: Wittkampf FHM, van Es R, Neven K. Journal: JACC Clin Electrophysiol. 2018 Aug;4(8):977-986. doi: 10.1016/j.jacep.2018.06.005. Epub 2018 Jul 25. PMID: 30139498