Verma Atul, Feld Gregory K, Cox James L, Dewland Thomas A, Babkin Alexei, De Potter Tom, Raju Narayan, Haissaguerre Michel
McGill University Health Centre, Division of Cardiology, Montreal, Quebec, Canada.
Division of Cardiology, University of California San Diego, La Jolla, California, USA.
J Cardiovasc Electrophysiol. 2023 Oct;34(10):2124-2133. doi: 10.1111/jce.15701. Epub 2022 Oct 25.
Combining pulsed field ablation (PFA) with ultra-low temperature cryoablation (ULTC) represents a novel energy source which may create more transmural cardiac lesions. We sought to assess the feasibility of lesions created by combined cryoablation and pulsed field ablation (PFCA) versus PFA alone.
Ablations were performed using a custom PFA generator, ULTC console, and an ablation catheter with insertable stylets. PFA was delivered in a biphasic, bipolar train. PFCA precooled the tissue for 30 s followed by a concurrent PFA train. Benchtop testing using Schlieren imaging and microbubble volume assessment were used to compare PFA and PFCA. PFA and PFCA lesions using pre-optimized and optimized ablation protocols were studied in 6 swine. Pre and post-ECGs were recorded for each ablation and a gross necropsy was performed at 14 days.
Consistent with benchtop comparisons of heat and microbubble generation, PFA deliveries in the animals were accompanied by muscle contractions and significant microbubbles (Grade 2-3) visible on intracardiac echo while neither occurred during PFCA at higher voltage levels. Both PFA and PFCA acutely eliminated or highly attenuated (>80%) local atrial electrograms. Histology of PFA and PFCA lesions indicated depth up to 6-7 mm and nearly all lesions were transmural. Optimized PFCA produced wider cavotricuspid isthmus lesions with evidence of tissue selectivity.
A novel technology combining PFA and ULTC into one energy source demonstrated in-vivo feasibility for PFCA ablation. PFCA had a more favorable thermal profile and did not produce muscle contraction or microbubbles while extending lesion depth beyond cryoablation.
将脉冲场消融（PFA）与超低温冷冻消融（ULTC）相结合代表了一种新型能量源，可能会产生更多透壁性心脏损伤。我们试图评估联合冷冻消融和脉冲场消融（PFCA）与单独使用PFA所产生损伤的可行性。
使用定制的PFA发生器、ULTC控制台和带有可插入管心针的消融导管进行消融。PFA以双相双极序列发放。PFCA先将组织预冷30秒，然后同时进行PFA序列发放。使用纹影成像和微泡体积评估进行的台式测试用于比较PFA和PFCA。在6头猪身上研究了使用预优化和优化消融方案的PFA和PFCA损伤。每次消融前后记录心电图，并在14天时进行大体尸检。
与台式测试中热生成和微泡生成的比较一致，动物体内进行PFA发放时伴有肌肉收缩，心内超声可见明显微泡（2 - 3级），而在较高电压水平的PFCA过程中均未出现。PFA和PFCA均能急性消除或高度衰减（>80%）局部心房电图。PFA和PFCA损伤的组织学显示深度达6 - 7毫米，几乎所有损伤都是透壁的。优化后的PFCA产生了更宽的腔静脉峡部损伤，并有组织选择性的证据。
一种将PFA和ULTC结合为一种能量源的新技术在体内证明了PFCA消融的可行性。PFCA具有更有利的热分布，不会产生肌肉收缩或微泡，同时将损伤深度扩展到超过冷冻消融。
