McBride Shauna, Avazzadeh Sahar, Wheatley Antony M, O'Brien Barry, Coffey Ken, Elahi Adnan, O'Halloran Martin, Quinlan Leo R
Physiology and Cellular Physiology Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human Biology Building, National University of Ireland (NUI) Galway, H91 W5P7 Galway, Ireland.
AtriAN Medical Limited, Unit 204, NUIG Business Innovation Centre, Upper Newcastle, H91 R6W6 Galway, Ireland.
J Clin Med. 2021 Jun 16;10(12):2657. doi: 10.3390/jcm10122657.
Targeted cellular ablation is being increasingly used in the treatment of arrhythmias and structural heart disease. Catheter-based ablation for atrial fibrillation (AF) is considered a safe and effective approach for patients who are medication refractory. Electroporation (EPo) employs electrical energy to disrupt cell membranes which has a minimally thermal effect. The nanopores that arise from EPo can be temporary or permanent. Reversible electroporation is transitory in nature and cell viability is maintained, whereas irreversible electroporation causes permanent pore formation, leading to loss of cellular homeostasis and cell death. Several studies report that EPo displays a degree of specificity in terms of the lethal threshold required to induce cell death in different tissues. However, significantly more research is required to scope the profile of EPo thresholds for specific cell types within complex tissues. Irreversible electroporation (IRE) as an ablative approach appears to overcome the significant negative effects associated with thermal based techniques, particularly collateral damage to surrounding structures. With further fine-tuning of parameters and longer and larger clinical trials, EPo may lead the way of adapting a safer and efficient ablation modality for the treatment of persistent AF.
靶向细胞消融在心律失常和结构性心脏病的治疗中应用越来越广泛。对于药物难治性心房颤动（AF）患者，基于导管的消融被认为是一种安全有效的方法。电穿孔（EPo）利用电能破坏细胞膜，热效应极小。EPo产生的纳米孔可以是暂时的或永久的。可逆电穿孔本质上是短暂的，可维持细胞活力，而不可逆电穿孔会导致永久性孔形成，导致细胞内环境稳定丧失和细胞死亡。多项研究报告称，EPo在诱导不同组织细胞死亡所需的致死阈值方面表现出一定程度的特异性。然而，需要更多的研究来确定复杂组织中特定细胞类型的EPo阈值特征。不可逆电穿孔（IRE）作为一种消融方法似乎克服了与热基技术相关的重大负面影响，尤其是对周围结构的附带损伤。随着参数的进一步微调以及更长、更大规模的临床试验，EPo可能引领一种更安全、高效的消融方式用于治疗持续性AF。
