High-frequency irreversible electroporation for cardiac ablation using an asymmetrical waveform

René van Es,Fred H. M. Wittkampf,Kars Neven,Bastiaan C. Du Pré,Pieter A. F. Doevendans,Albert H. Westra,Vincent J. H. M. van Driel,Harry van Wessel,Maurits K. Konings

doi:10.1186/s12938-019-0693-7

Abstract

BackgroundIrreversible electroporation (IRE) using direct current (DC) is an effective method for the ablation of cardiac tissue. A major drawback of the use of DC-IRE, however, are two problems: requirement of general anesthesia due to severe muscle contractions and the formation of bubbles containing gaseous products from electrolysis. The use of high-frequency alternating current (HF-IRE) is expected to solve both problems, because HF-IRE produces little to no muscle spasms and does not cause electrolysis.MethodsIn the present study, we introduce a novel asymmetric, high-frequency (aHF) waveform for HF-IRE and present the results of a first, small, animal study to test its efficacy.ResultsThe data of the experiments suggest that the aHF waveform creates significantly deeper lesions than a symmetric HF waveform of the same energy and frequency (p = 0.003).ConclusionWe therefore conclude that the use of the aHF enhances the feasibility of the HF-IRE method.

Highlights

Irreversible electroporation (IRE) using direct current (DC) is an effective method for the ablation of cardiac tissue
Since the total charge released from the electrode during one single wave period must always be exactly equal to zero, we introduce an asymmetric waveform in which, for each single wave period, the surface area of the positive phase is equal to the surface area of the negative phase
The high-frequency alternating current (HF-IRE) applications were successfully delivered in all experiments without medical complications

Summary

Introduction

Irreversible electroporation (IRE) using direct current (DC) is an effective method for the ablation of cardiac tissue. The use of high-frequency alternating current (HF-IRE) is expected to solve both problems, because HF-IRE produces little to no muscle spasms and does not cause electrolysis. Thermal ablation, has many limitations and can lead to severe complications such as pulmonary vein stenosis, phrenic nerve palsy or in rare cases to paraesophageal fistula [1]. Irreversible electroporation (IRE) may be a safer and more effective method for cardiac ablation [2]. Preclinical studies have shown that IRE is a safe and valuable method for cardiac ablation therapy [3,4,5,6,7,8,9,10,11]. The high-intensity electric field near the catheter electrodes produces pores in the phospholipid membranes of the cells, leading to an irreversible breakdown of membrane structure and function and to cell death [12]

Methods

Results

Conclusion