Publication details

Irreversible electroporation ablation for atrial fibrillation

Authors

WOJTASZCZYK Adam CALUORI Guido PEŠL Martin MELAJOVÁ Katarína STÁREK Zdeněk

Type Article in Periodical
Magazine / Source Journal of Cardiovascular Electrophysiology
MU Faculty or unit

Faculty of Medicine

Citation
WWW https://onlinelibrary.wiley.com/doi/full/10.1111/jce.13454
Doi http://dx.doi.org/10.1111/jce.13454
Field Cardiovascular diseases incl. cardiosurgery
Keywords atrial fibrillation; fibrosis; irreversible electroporation; non-thermal ablation; pulmonary vein isolation
Description Atrial fibrillation (AF) is one of the most important problems in modern cardiology. Thermal ablation therapies, especially radiofrequency ablation (RF), are currently "gold standard" to treat symptomatic AF by localized tissue necrosis. Despite the improvements in reestablishing sinus rhythm using available methods, both success rate and safety are limited by the thermal nature of procedures. Thus, while keeping the technique in clinical practice, safer and more versatile methods of removing abnormal tissue are being investigated. This review focuses on irreversible electroporation (IRE), a non-thermal ablation method, that is based on the unrecoverable permeabilization of cell membranes caused by short pulses of high voltage/current. While still in its preclinical steps for what concerns interventional cardiac electrophysiology, multiple studies have shown the efficacy of this method on animal models. The observed remodeling process shows this technique as tissue specific, triggering apoptosis rather than necrosis, and safer for the structures adjacent the myocardium. So far, proposed IRE methodologies are heterogeneous. The number of devices (both generators and applicators), techniques and therapeutic goals impair the comparability of performed studies. More questions regarding systemic safety and optimal processes for AF treatment remain to be answered. This work provides an overview of the electroporation process, and presents different results obtained by cardiology-oriented research groups that employ IRE ablation, with focus of AF-related targets. This contribution on the topic aspires to be a practical guide to approach IRE ablation for cardiac arrhythmias, and to highlight controversial features and existing knowledge, to provide background for future improved experimentation with IRE in arrhythmology. This article is protected by copyright. All rights reserved.
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