From the Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (K.N., V.v.D., H.v.W., R.v.E., P.A.D., F.W.); Department of Rhythmology, Alfried Krupp Krankenhaus, Essen, Germany (K.N.); St. Jude Medical, Veenendaal, The Netherlands (H.v.W.); and ICIN-Netherlands Heart House, Utrecht, The Netherlands (P.A.D.).
Circ Arrhythm Electrophysiol. 2014 Aug;7(4):728-33. doi: 10.1161/CIRCEP.114.001659. Epub 2014 Jul 11.
Irreversible electroporation is a promising nonthermal ablation modality able to create deep myocardial lesions. We investigated lesion size after epicardial electroporation catheter ablation with various energy levels after subxiphoid pericardial puncture.
In six 6-month-old pigs (60-75 kg), a custom deflectable octopolar 12-mm circular catheter with 2-mm ring electrodes was introduced via a deflectable sheath after pericardial access by subxiphoid puncture. Nonarcing, nonbarotraumatic, cathodal 50, 100, and 200 J electroporation applications were delivered randomly on the basal, mid and lateral left ventricle. After 3-month survival, myocardial lesion size and degree of intimal hyperplasia of the coronary arteries were analyzed histologically. Five animals survived the follow-up without complications and 1 animal died of shock after the subxiphoid puncture. At autopsy, whitish circular scars with indentation of the epicardium could be identified. Average lesion depths of the 50-, 100-, and 200-J lesions were 5.0±2.1, 7.0±2.0, and 11.9±1.5 mm, respectively. Average lesion widths of the 50-, 100-, and 200-J lesions were 16.6±1.1, 16.2±4.3, and 19.8±1.8 mm, respectively. In the 100- and 200-J cross sections, transmural left ventricular lesions and significant tissue shrinkage were observed. No intimal hyperplasia of the coronary arteries was observed.
Epicardial electroporation ablation after subxiphoid pericardial puncture can create deep, wide, and transmural ventricular myocardial lesions. There is a significant relationship between the amounts of electroporation energy delivered epicardially and lesion size in the absence of major adverse events.
不可逆电穿孔是一种有前途的非热消融方式，能够在心肌内产生深达的损伤。我们通过剑突下心包穿刺，研究了心外膜电穿孔导管消融后不同能量水平下的损伤大小。
在 6 只 6 月龄（60-75kg）猪中，通过剑突下心包穿刺进入心包腔后，采用可弯曲鞘管引入一种定制的可弯曲的八极 12mm 圆形导管，其带有 2mm 环电极。随机在心外膜的基底、中间和左侧心室的外侧给予无电弧、无气压伤、阴极的 50、100 和 200J 电穿孔应用。在 3 个月的生存后，通过组织学分析评估心肌损伤大小和冠状动脉内膜增生程度。5 只动物在没有并发症的情况下存活下来，1 只动物在剑突下心包穿刺后死于休克。尸检时，可以识别出带有心外膜压痕的白色圆形疤痕。50J、100J 和 200J 损伤的平均损伤深度分别为 5.0±2.1、7.0±2.0 和 11.9±1.5mm。50J、100J 和 200J 损伤的平均损伤宽度分别为 16.6±1.1、16.2±4.3 和 19.8±1.8mm。在 100J 和 200J 的横截面上，观察到贯穿左心室的损伤和明显的组织收缩。未观察到冠状动脉内膜增生。
通过剑突下心包穿刺进行心外膜电穿孔消融可以产生深达、广泛和贯穿左心室心肌的损伤。在心外膜给予的电穿孔能量与损伤大小之间存在显著的关系，而没有发生重大不良事件。
