Abstract
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.
Highlights
Introduction iationsThe Centers for Disease Control and Prevention in the USA reports that 1 in every4 deaths in the United States is related to general cardiovascular disease, with an estimated12.1 million people predicted to develop arrhythmias such as atrial fibrillation (AF) by2030 [1]
This review considers the factors involved in achieving successful ablation of cardiac the available data exploring energy-based ablative technologies, highlight the differing tissue and the been evidence from in avitro andfocus in vivo preclinical work which has informed modalities that have developed with particular on anti-arrhythmic therapies
Hyperthermal approaches can use various energy sources including the use of ultrasound, lasers, radiofrequency technology applied via electrode catheter, or hot balloon ablation systems [11,12]
Summary
Arrhythmia procedures have been developed to date, such as alcohol septal ablation, which involves the injection of ethanol into the Several relatively simple non-invasive ablative procedures have been developed to septal coronary artery to target ofinjection the septal wall into [5]. the. This minimally invasive date, such as alcohol septal ablation, whichportions involves the of ethanol septal ablation method has been extensively employed as a treatment for structural related heart coronary artery to target portions of the septal wall [5]. Alcohol septal ablation is often applied when previous lower intensity therapies therapies have failed [5]. Stereotactic radioablation is another non-invasive modality under have failed [5]. Invasive entrycavity into tothe body cavity to access targeted areas of the myocardium (Figure 1). Access via an epicardial approach can be achieved through ports in the intercostal spaces (1B), a sub-xiphoid puncture (2B) or via open heart surgery (3B). Substrate approaches is often made in relation to the target area and patient’s disease substrate [10]
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