van Zyl Martin, Khabsa Mariam, Tri Jason A, Ladas Thomas P, Yasin Omar Z, Ladejobi Adetola O, Reilly John, O'Brien Barry, Coffey Kenneth, Asirvatham Samuel J
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
AtriAN Medical Ltd., Galway, Ireland.
J Innov Card Rhythm Manag. 2022 Jul 15;13(7):5061-5069. doi: 10.19102/icrm.2022.130704. eCollection 2022 Jul.
This study aimed to evaluate the safety and acute effect on markers of cardiac autonomic tone following pulsed electric fields (PEFs) delivered to epicardial ganglionated plexi (GP) during a cardiac surgical procedure. Ablation of GP as a treatment for atrial fibrillation (AF) has shown promise, but thermal ablation energy sources are limited by the risk of inadvertent collateral tissue injury. In acute canine experiments, median sternotomy was performed to facilitate the identification of 5 epicardial GP regions using an anatomy-guided approach. Each site was targeted with saline-irrigated PEF (1000 V, 100 μs, 10 electrocardiogram [ECG]-synchronized pulse sequences). Atrial effective refractory period (AERP) and local electrogram (EGM) amplitude were measured before and after each treatment. Histology was performed on samples from treatment-adjacent structures. In 5 animals, 30 (n = 2) and 60 (n = 3) pulses were successfully delivered to each of the 5 target sites. There was no difference in local atrial EGM amplitude before and after PEF application at each site (1.83 ± 0.41 vs. 1.92 ± 0.53 mV, = .72). The mean AERP increased from 97 ± 15 ms at baseline to 115 ± 7 ms following treatment at all sites (18.6% increase; 95% confidence interval, 1.9-35.2; = .037). There were no sustained ventricular arrhythmias or acute evidence of ischemia following delivery. Histology showed complete preservation of adjacent atrial myocardium, phrenic nerves, pericardium, and esophagus. Use of PEF to target regions rich in cardiac GP in open-chest canine experiments was feasible and effective at acutely altering markers of cardiac autonomic tone.
本研究旨在评估在心脏手术过程中，将脉冲电场（PEF）施加于心外膜神经节丛（GP）后，其对心脏自主神经张力标志物的安全性和急性影响。消融GP作为治疗心房颤动（AF）的一种方法已显示出前景，但热消融能量源受到意外附带组织损伤风险的限制。在急性犬实验中，采用正中胸骨切开术，通过解剖学引导方法便于识别5个心外膜GP区域。每个部位均接受盐水灌注的PEF（1000V，100μs，10个心电图[ECG]同步脉冲序列）靶向治疗。在每次治疗前后测量心房有效不应期（AERP）和局部电图（EGM）振幅。对治疗相邻结构的样本进行组织学检查。在5只动物中，成功地将30（n = 2）和60（n = 3）个脉冲分别施加到5个靶部位中的每一个。在每个部位施加PEF前后，局部心房EGM振幅无差异（1.83±0.41对1.92±0.53mV，P = 0.72）。所有部位治疗后，平均AERP从基线时的97±15ms增加到115±7ms（增加18.6%；95%置信区间，1.9 - 35.2；P = 0.037）。施加后未出现持续性室性心律失常或急性缺血证据。组织学显示相邻心房心肌、膈神经、心包和食管完全保留。在开胸犬实验中，使用PEF靶向富含心脏GP的区域，在急性改变心脏自主神经张力标志物方面是可行且有效的。
