ExperimentalAbsence of (sub-)acute cerebral events or lesions after electroporation ablation in the left-sided canine heart
Introduction
Irreversible electroporation is a novel, nonthermal ablation modality. Within milliseconds, a single application can create transmural myocardial lesions with no adverse effects, such as coronary artery or pulmonary vein stenosis, persistent phrenic nerve palsy, or esophageal damage.1, 2, 3, 4, 5, 6, 7, 8, 9
Due to electrical phenomena (eg, electrolysis), gas bubble formation can occur.10 Studies on magnetic resonance imaging (MRI)–detected asymptomatic cerebral events/lesions after cardiac ablation have increased awareness of possible cerebral complications.11 Acute and subacute effects of this new energy source on the brain are unknown. In the present study, canine brain tissue was examined for lesions following electroporation or radiofrequency ablation to the left side of the heart.
Section snippets
Methods
All experiments were approved by the Institutional Animal Care and Use Committee of a United States Department of Agriculture (USDA)–registered facility, accredited by the Association for the Assessment and Accreditation of Laboratory Animal Care International. This study was performed in compliance with the Guide for the Care and Use of Laboratory Animals.12
Results
The first 3 animals did not complete the study. One animal was withdrawn before treatment due cerebral asymmetry found during the pretreatment MRI. Two animals died during the treatment phase due to surgical complications resulting in unconvertable ventricular fibrillation in 1 animal and cardiac tamponade in the other animal. These 2 complications could be attributed to a learning curve and getting acquainted with operating on a canine animal model. The remaining 11 animals were successfully
Discussion
Cardiac tissue is commonly ablated by resistive heating as radiofrequency energy is delivered to targeted sites.14 Procedure-associated stroke, as a severe disabling complication, is rare and occurs in <1% of cases. Recent studies have identified symptomatic stroke to be only a minority of cerebral ischemic events, as postablation brain MRI identified new ischemic lesions in up to 50% of cases.15, 16, 17 Positive MRI findings may occur in patients without apparent neurologic deficit and
Conclusion
In this 5-day study, 9 canines were treated with high-energy electroporation treatments and 2 canines were treated with radiofrequency ablations. All treatments were intended to mimic clinical conditions anticipated during the ablation of left-sided cardiac sites. Evidence of solid and gas bubble–induced microembolic brain lesions were sought using radiologic and histopathologic methodologies. MRI scans alone or in combination with histologic follow-up did not reveal treatment-related embolic
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Funding sources: This study was funded by Abbott, Inc. Disclosures: Drs Neven, Feeney, and Donskoy are consultants for Abbott, Inc. Mr Byrd, Mr Fish, Mr Ronald W. Heil, Jr., and Mr Jensen were employees of Abbott, Inc., at the time this study was conducted. Dr Füting has reported that she has no relationships relevant to the contents of this paper to disclose.