Electroporation (Revival of Direct Current Ablation)

Abstract

Several different techniques and energy sources have been developed for catheter ablation of tachyarrhythmias, including atrial fibrillation and ventricular tachycardia.1–3 Radiofrequency (RF) current is the most commonly used energy source for ablation. Although RF ablation has been proven to be effective, there are several limitations, including relatively long procedure times and high recurrence rate, especially for ablation of atrial fibrillation and ventricular tachycardia.2,3 During RF ablation, excessive tissue heating may lead to serious complications, such as steam pop, cardiac perforation, pulmonary vein stenosis, coronary arterial injury, and thrombo-embolism.1–4 Conversely, tissue cooling by arterial flow (providing greater heat sink) may limit RF lesion formation and lead to gaps in the ablation line, such as linear ablation across the mitral isthmus.5,6 Article see p 913 Direct current (DC) catheter ablation technique was initiated in early 1980s, but was abandoned shortly after RF ablation became available in 1990s.7 DC ablation was associated with serious complications, supposedly related to barotrauma and proarrhymia.8,9 Barotrauma is caused by a high-pressure shock wave resulting from an electrically isolating vapor globe, leading to arcing (spark) and explosion.8 At the …