Irreversible Electroporation as an Emerging Cardiac Ablation Modality and its Potential for Collateral Tissue Damage

Abstract

ObjectivesOver the last few years the field of cardiac ablations to treat arrhythmias has been shaken by the re-emergence of an again considered new technology, irreversible electroporation. This thesis explores the effects of irreversible electroporation on the heart and its potential for impact collateral tissue damage relative to clinically applied ablation protocols. Methods Both in vivo and in vitro pre-clinical research experiments were implemented to analyze how irreversible electroporation affected tissues that are considered collateral to an applied cardiac ablation. These experimental approaches ranged from isolated muscle and nerve studies, to in vivo swine protocols, to those within reanimated swine and human hearts. Results In general, electroporative therapy is considered to be tissue selective and thus can be safely used to ablate cardiac arrhythmias while sparing collateral ones. In other words, different tissues responded variably to electroporation, mainly in induced contractile function. For examples, coronary arteries at high electroporative energies elicited acute vascular spasm, while the contractilities of swine skeletal muscle responded even to low lethal electric field levels: also dependent on the waveforms applied. Conclusion Irreversible electroporation of cardiac arrhythmia is a promising emerging technology, but clinically there are still many things to understand relative to it’s safe applications. In general, smooth muscle appears more easily ablated; yet structural integrity at most therapeutically applied energies was maintained. The chronic effects of electroporation on the potential for muscle loss have yet to be fully determined chronically. An important consideration for all types of applied cardiac ablations are the potential to induce acute spasms of coronary vessels, this could potentially be more dangerous for the patient with coronary artery disease.