Dynamics of High-Density Unipolar Epicardial Electrograms During PFA
Gerard Amorós-Figueras1, Sergi Casabella-Ramon2, Zoraida Moreno-Weidmann1
1Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), CIBERCV, Universitat Autònoma de Barcelona, Spain (G.A.-F., Z.M.-W., J.M.G.).
Circulation. Arrhythmia and Electrophysiology
|August 14, 2023
Summary
Pulsed field ablation (PFA) creates distinct electrogram changes in irreversible electroporation (IRE) and reversible electroporation zones. These electrogram dynamics help differentiate lesion areas immediately after PFA, aiding in acute assessment.
Area of Science:
- Cardiovascular Ablation Technologies
- Electrophysiology
- Biophysics
Background:
- Pulsed field ablation (PFA) is a novel nonthermal cardiac ablation method utilizing irreversible electroporation (IRE).
- Understanding electrogram behavior in reversible electroporation zones, which recover post-ablation, is crucial.
- Local electrogram dynamics in response to varying electroporation levels after PFA are not well-characterized.
Purpose of the Study:
- To characterize electrogram dynamics following PFA in both IRE and reversible electroporation areas.
- To investigate the differences in electrogram behavior between IRE and reversible electroporation zones post-ablation.
Main Methods:
- Domestic swine underwent epicardial PFA and radiofrequency ablation.
- High-density electrograms were recorded for 60 minutes post-ablation.
- Electrograms were analyzed in relation to electroporation levels and lesion depth was assessed via staining.
Main Results:
- PFA induced significant electrogram changes including decreased R/S amplitude, ST-segment elevation, and reduced |(dV/dt)|max.
- Electrogram changes were observed beyond the primary lesion area and showed distinct patterns in IRE vs. reversible electroporation zones.
- PFA lesions demonstrated greater depth compared to radiofrequency ablation lesions.
Conclusions:
- Unipolar electrograms can differentiate between reversible electroporation and IRE areas within 30 minutes post-PFA.
- Observed electrogram differences become less distinct after 30 minutes.
- Findings support the utility of electrograms for immediate PFA lesion assessment and suggest further research.
Keywords:
cardiac arrhythmiaselectrophysiologic techniques, cardiacepicardial mappingirreversible electroporationpulse field ablationreversible electroporationMore Related Videos
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