Neven Kars, van Driel Vincent, van Wessel Harry, van Es René, Doevendans Pieter A, Wittkampf Fred
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany.
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Heart Rhythm. 2014 Aug;11(8):1465-70. doi: 10.1016/j.hrthm.2014.04.031. Epub 2014 Apr 21.
Electroporation can be used as a nonthermal method to ablate myocardial tissue. However, like with all electrical ablation methods, determination of the energy supplied into the myocardium enhances the clinically required controllability over lesion creation.
To investigate the relationship between the magnitude of epicardial electroporation ablation and the lesion size using an electrically isolating linear suction device.
In 5 pigs (60-75 kg), the pericardium was opened after medial sternotomy. A custom linear suction device with a single 35 × 6-mm electrode inside a 42-mm-long and 7-mm-wide plastic suction cup was used for electroporation ablation. Single cathodal applications of 30, 100, or 300 J were delivered randomly at 3 different epicardial left ventricular sites. Coronary angiography was performed before ablation, immediately after ablation, and after 3 months survival. Lesion size was measured histologically after euthanization.
The mean depth of 30, 100, and 300 J lesions was 3.2 ± 0.7, 6.3 ± 1.8, and 8.0 ± 1.5 mm, respectively (P = .0003). The mean width of 30, 100, and 300 J lesions was 10.1 ± 0.8, 15.1 ± 1.5, and 17.1 ± 1.3 mm, respectively (P<.0001). Significant tissue shrinkage was observed at the higher energy levels. No luminal arterial narrowing was observed after 3 months: 2.3 ± 0.3 mm vs 2.3 ± 0.4 mm (P = .85).
The relationship between the amount of electroporation energy delivered through a linear suction device with a single linear electrode and the mean myocardial lesion size is significant in the absence of major adverse events or permanent damage to the coronary arteries.
电穿孔可作为一种非热方法用于消融心肌组织。然而，与所有电消融方法一样，确定供应到心肌的能量可增强临床上对病灶形成所需的可控性。
使用电隔离线性吸引装置研究心外膜电穿孔消融的强度与病灶大小之间的关系。
在5头猪（60 - 75千克）身上，经胸骨正中切开术后打开心包。使用定制的线性吸引装置，在一个42毫米长、7毫米宽的塑料吸引杯内有一个35×6毫米的单电极用于电穿孔消融。在左心室心外膜的3个不同部位随机施加30、100或300焦耳的单次阴极电脉冲。在消融前、消融后即刻以及存活3个月后进行冠状动脉造影。安乐死后通过组织学测量病灶大小。
30、100和300焦耳病灶的平均深度分别为3.2±0.7、6.3±1.8和8.0±1.5毫米（P = 0.0003）。30、100和300焦耳病灶的平均宽度分别为10.1±0.8、15.1±1.5和17.1±1.3毫米（P<0.0001）。在较高能量水平观察到明显的组织收缩。3个月后未观察到管腔动脉狭窄：2.3±0.3毫米对2.3±0.4毫米（P = 0.85）。
在没有重大不良事件或冠状动脉永久性损伤的情况下，通过带有单个线性电极的线性吸引装置传递的电穿孔能量量与平均心肌病灶大小之间的关系显著。
