Efficacy of a surgical cardiac ablation clamp using nanosecond pulsed electric fields: An acute porcine model.

Autor:	Yu J; Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo; Division of Cardiothoracic Surgery, Department of Surgery, Navamindradhiraj University, Vajira Hospital, Bangkok, Thailand., Yi J; Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo., Nikolaisen G; Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo., Wilson LD; Division of Comparative Medicine, Washington University School of Medicine, St. Louis, Mo., Schill MR; Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo., Damiano RJ Jr; Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo., Zemlin CW; Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Mo. Electronic address: zemlinc@wustl.edu.
Jazyk:	angličtina
Zdroj:	The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Jun 20. Date of Electronic Publication: 2024 Jun 20.
DOI:	10.1016/j.jtcvs.2024.06.009
Abstrakt:	Objective: To examine the effectiveness of a recently developed nonthermal technology, nanosecond pulse-field ablation (nsPFA), for surgical ablation of the atria in a beating heart porcine model. Methods: Six pigs underwent sternotomy and ablation using an nsPFA parallel clamp. The ablation electrodes (53 mm long) were embedded in the jaws of the clamp. Nine lesions per pig were created in locations chosen to be representative of the Cox-maze procedure. Four lesions were intended to electrically isolate parts of the atrium: the right atrial appendage, left atrial appendage, right pulmonary veins, and left pulmonary veins. For these lesions, exit block testing was performed both after ablation and before euthanasia; the time between the 2 tests was 3.3 ± 0.5 hours (range, 2-4 hours). Using purse string sutures, 5 more lesions were created up to the superior vena cava, down to the inferior vena cava, across the right atrial free wall, and at 2 distinct locations on the left atrial free wall. The clamp delivered a train of nanosecond duration pulses, with a total duration of 2.5 seconds, independent of tissue thickness. The heart tissue was stained with 1% triphenyltetrazolium chloride after a dwelling period of 2 hours. Subsequently, each lesion was cross sectioned at 5-mm intervals to assess the ablation depth and transmurality. In some sections, transmurality could not be established on the basis of triphenyltetrazolium chloride staining alone; for these lesions, Gomori-trichrome stains were used, and the histologic sections were evaluated for transmurality. Results: The ablation time was 2.5 seconds per lesion, for a total of only 22.5 seconds ablation time to create 9 lesions. A total of 53 lesions were created, resulting in 388 separate histologic sections. Transmurality was established in 386 sections (99.5%). Mean tissue thickness was 3.1 ± 1.5 mm (range, 0.2-8.6 mm). Exit block was confirmed in 23 of the 24 lesions (96%) postablation and 23 of 24 (96%) before the animals were humanely killed. Over the course of the procedure, neither pulse-induced arrhythmias nor any other complications were noted. Conclusions: The novel nsPFA clamp device was effective in creating acute conduction block and transmural lesions in both the right and left atria in an acute porcine model. This nonthermal energy source has great potential to both shorten procedural time and enable effective ablation in the beating heart. Competing Interests: Conflict of Interest Statement Dr Zemlin holds stock in Pulse Biosciences, Inc, and receives research funding from Pulse Biosciences, Inc. Dr Damiano reported research funding from Pulse Biosciences, Inc; speaker and receives research funding from AtriCure, Inc; and speaker and consultant for Medtronic and Edwards Lifesciences. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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