Kars Neven1, René van Es2, Vincent van Driel2, Harry van Wessel2, Herma Fidder2, Aryan Vink2, Pieter Doevendans2, Fred Wittkampf2. 1. From the Departments of Cardiology (K.N., R.v.E., V.v.D., H.v.W., P.D., F.W.), Gastroenterology (H.F.), and Pathology (A.V.), University Medical Center Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen (K.N.); Witten/Herdecke University, Germany (K.N.); St Jude Medical, Veenendaal (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.D.). kars_neven@hotmail.com. 2. From the Departments of Cardiology (K.N., R.v.E., V.v.D., H.v.W., P.D., F.W.), Gastroenterology (H.F.), and Pathology (A.V.), University Medical Center Utrecht, The Netherlands; Department of Rhythmology, Alfried Krupp Krankenhaus, Essen (K.N.); Witten/Herdecke University, Germany (K.N.); St Jude Medical, Veenendaal (H.v.W.); and ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (P.D.).
Abstract
BACKGROUND: Esophageal ulceration and fistula are complications of pulmonary vein isolation using thermal energy sources. Irreversible electroporation is a novel, nonthermal ablation modality for pulmonary vein isolation. A single 200 J application can create deep myocardial lesions. Acute and chronic effects of this new energy source on the esophagus are unknown. METHODS AND RESULTS: In 8 pigs (±70 kg), the suprasternal esophagus was surgically exposed. A linear suction device with a single 35-mm long and 6-mm wide protruding linear electrode inside a plastic suction cup was used for ablation. Single, nonarcing, nonbarotraumatic, cathodal 100 and 200 J applications were delivered at 2 different sites on the anterior esophageal adventitia. No proton-pump inhibitors were administered during follow-up. Esophagoscopy was performed at days 2 and 7. After euthanasia at day 60, the esophagus was evaluated visually and histologically. All ablations were uneventful. Esophagoscopy at day 2 showed small white densities in the ablated areas, which appeared to be small intraepithelial vesicles. No epithelial erythema, erosions, or ulcerations were seen. At day 7, all densities had disappeared, and all esophaguses appeared completely normalized. After euthanasia, there were no macroscopically visible lesions on the adventitia or epithelium. Histologically, a small scar was observed at the outer part of the muscular layer, whereas the mucosa and submucosa were normal. CONCLUSIONS: Esophageal architecture remains unaffected 2 months after irreversible electroporation, purposely targeting the adventitia. Irreversible electroporation seems to be a safe modality for catheter ablation near the esophagus.
BACKGROUND: Esophageal ulceration and fistula are complications of pulmonary vein isolation using thermal energy sources. Irreversible electroporation is a novel, nonthermal ablation modality for pulmonary vein isolation. A single 200 J application can create deep myocardial lesions. Acute and chronic effects of this new energy source on the esophagus are unknown. METHODS AND RESULTS: In 8 pigs (±70 kg), the suprasternal esophagus was surgically exposed. A linear suction device with a single 35-mm long and 6-mm wide protruding linear electrode inside a plastic suction cup was used for ablation. Single, nonarcing, nonbarotraumatic, cathodal 100 and 200 J applications were delivered at 2 different sites on the anterior esophageal adventitia. No proton-pump inhibitors were administered during follow-up. Esophagoscopy was performed at days 2 and 7. After euthanasia at day 60, the esophagus was evaluated visually and histologically. All ablations were uneventful. Esophagoscopy at day 2 showed small white densities in the ablated areas, which appeared to be small intraepithelial vesicles. No epithelial erythema, erosions, or ulcerations were seen. At day 7, all densities had disappeared, and all esophaguses appeared completely normalized. After euthanasia, there were no macroscopically visible lesions on the adventitia or epithelium. Histologically, a small scar was observed at the outer part of the muscular layer, whereas the mucosa and submucosa were normal. CONCLUSIONS: Esophageal architecture remains unaffected 2 months after irreversible electroporation, purposely targeting the adventitia. Irreversible electroporation seems to be a safe modality for catheter ablation near the esophagus.
Authors: Thomas J Buist; Marijn H A Groen; Fred H M Wittkampf; Peter Loh; Pieter A F M Doevendans; René van Es; Arif Elvan Journal: Cardiovasc Eng Technol Date: 2022-06-16 Impact factor: 2.495
Authors: Frency Varghese; Jonathan M Philpott; Johanna U Neuber; Barbara Hargrave; Christian W Zemlin Journal: Cardiovasc Eng Technol Date: 2022-06-15 Impact factor: 2.495
Authors: Chance M Witt; Alan Sugrue; Deepak Padmanabhan; Vaibhav Vaidya; Sarah Gruba; James Rohl; Christopher V DeSimone; Ammar M Killu; Niyada Naksuk; Joanne Pederson; Scott Suddendorf; Dorothy J Ladewig; Elad Maor; David R Holmes; Suraj Kapa; Samuel J Asirvatham Journal: J Am Heart Assoc Date: 2018-07-09 Impact factor: 5.501