Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
Department of Extracorporeal Circulation, St. Antonius Hospital, Nieuwegein, The Netherlands.
Europace. 2021 Jan 27;23(1):139-146. doi: 10.1093/europace/euaa243.
Irreversible electroporation (IRE) ablation is a non-thermal ablation method based on the application of direct current between a multi-electrode catheter and skin electrode. The delivery of current through blood leads to electrolysis. Some studies suggest that gaseous (micro)emboli might be associated with myocardial damage and/or (a)symptomatic cerebral ischaemic events. The aim of this study was to compare the amount of gas generated during IRE ablation and during radiofrequency (RF) ablation.
In six 60-75 kg pigs, an extracorporeal femoral shunt was outfitted with a bubble-counter to detect the size and total volume of gas bubbles. Anodal and cathodal 200 J IRE applications were delivered in the left atrium (LA) using a 14-electrode circular catheter. The 30 and 60 s 40 W RF point-by-point ablations were performed. Using transoesophageal echocardiography (TOE), gas formation was visualized. Average gas volumes were 0.6 ± 0.6 and 56.9 ± 19.1 μL (P < 0.01) for each anodal and cathodal IRE application, respectively. Also, qualitative TOE imaging showed significantly less LA bubble contrast with anodal than with cathodal applications. Radiofrequency ablations produced 1.7 ± 2.9 and 6.7 ± 7.4 μL of gas, for 30 and 60 s ablation time, respectively.
Anodal IRE applications result in significantly less gas formation than both cathodal IRE applications and RF applications. This finding is supported by TOE observations.
不可逆电穿孔（IRE）消融是一种基于多电极导管和皮肤电极之间施加直流电的非热消融方法。电流通过血液传输会导致电解。一些研究表明，气态（微）栓子可能与心肌损伤和/或（症状性）脑缺血事件有关。本研究旨在比较 IRE 消融和射频（RF）消融过程中产生的气体量。
在 6 只 60-75kg 的猪中，股外分流器配备了一个气泡计数器，以检测气泡的大小和总体积。使用 14 电极圆形导管在左心房（LA）进行阳极和阴极 200J 的 IRE 应用。进行了 30 和 60s 的 40W RF 点烧蚀。使用经食管超声心动图（TOE）可视化气体形成。每个阳极和阴极 IRE 应用的平均气体体积分别为 0.6±0.6 和 56.9±19.1μL（P<0.01）。此外，TOE 定性成像显示阳极应用比阴极应用的 LA 气泡对比度明显更低。RF 消融产生的气体量分别为 30s 和 60s 消融时间的 1.7±2.9 和 6.7±7.4μL。
与阴极 IRE 应用和 RF 应用相比，阳极 IRE 应用产生的气体形成量明显更少。TOE 观察结果支持这一发现。
