Ventricular nanosecond pulsed electric field delivery using active fixation leads: a proof-of-concept preclinical study

Nicholas Y. Tan, Thomas P. Ladas, Georgios Christopoulos, Alan M. Sugrue, Martin van Zyl, Adetola O. Ladejobi, Fahad K. Lodhi, Tiffany Y. Hu, Fatima M. Ezzeddine, Kolade Agboola, Darrin Uecker, Elad Maor, Jason A. Tri, Zhi Jiang, Omar Z. Yasin, Christopher V. DeSimone, Ammar M. Killu, Samuel J. Asirvatham, Freddy Del-Carpio Munoz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Mid-myocardial ventricular arrhythmias are challenging to treat. Cardiac electroporation via pulsed electric fields (PEFs) offers significant promise. We therefore tested PEF delivery using screw-in pacemaker leads as proof-of-concept. Methods: In 5 canine models, we applied nanosecond PEF (pulse width 300 ns) across the right ventricular (RV) septum using a single lead bipolar configuration (n = 2) and between two leads (n = 3). We recorded electrograms (EGMs) prior to, immediately post, and 5 min after PEF. Cardiac magnetic resonance imaging (cMRI) and histopathology were performed at 2 weeks and 1 month. Results: Nanosecond PEF induced minimal extracardiac stimulation and frequent ventricular ectopy that terminated post-treatment; no canines died with PEF delivery. With 1 lead, energy delivery ranged from 0.64 to 7.28 J. Transient ST elevations were seen post-PEF. No myocardial delayed enhancement (MDE) was seen on cMRI. No lesions were noted on the RV septum at autopsy. With 2 leads, energy delivery ranged from 56.3 to 144.9 J. Persistent ST elevations and marked EGM amplitude decreases developed post-PEF. MDE was seen along the septum 2 weeks and 1 month post-PEF. There were discrete fibrotic lesions along the septum; pathology revealed dense connective tissue with < 5% residual cardiomyocytes. Conclusions: Ventricular electroporation is feasible and safe with an active fixation device. Reversible changes were seen with lower energy PEF delivery, whereas durable lesions were created at higher energies. Graphical abstract: Central illustration: pulsed electric field delivery into ventricular myocardium with active fixation leads [Figure not available: see fulltext.]

Original languageEnglish
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - 2022
Externally publishedYes

Funding

FundersFunder number
Heart Rhythm Society

    Keywords

    • Cardiac ablation
    • Electroporation
    • Pulsed electric field
    • Ventricular tachycardia

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