Pulsed Field Ablation of Left Ventricular Myocardium in a Swine Infarct Model.

BACKGROUND: Pulsed field ablation (PFA) leads to cell death by irreversible electroporation. There are limited data about PFA lesion characteristics in the ventricle, particularly in the presence of myocardial scar. OBJECTIVES: This study sought to evaluate the lesion characteristics of PFA and radiofrequency energy (RFA) in healthy and infarcted left ventricular (LV) myocardium in swine. METHODS: Swine (n = 10) underwent either: 1) 120-minute left anterior descending coronary artery balloon occlusion myocardial infarction and survived for 6 to 8 weeks (n = 8); or 2) served as healthy control subjects (n = 2). PFA or RFA was delivered to the LV endocardium in regions of healthy myocardium or scar identified with electroanatomical mapping. Bipolar, biphasic PFA was delivered for 2.5 seconds × 4 applications/site using 2 different catheters: linear quadripolar (FOCAL) or multispline 8-pole catheter (BASKET). Gross and histologic measurements of lesion size were performed. RESULTS: In the PFA group, 21 lesions were delivered to healthy LV and 20 to areas of scar. Overall, there was no significant difference in lesion depth between catheter groups (FOCAL linear vs BASKET; P = 0.740), whereas lesion width was greater for BASKET (10.6 ± 2.4 mm vs 13.3 ± 3.3 mm; P = 0.007). In myocardial scar, lesion depth was not significantly different between PFA catheters (P = 0.235). However, lesion depth for PFA was greater than for RFA (PFA vs RFA; 6.1 ± 1.7 mm vs 3.8 ± 1.7 mm; P = 0.005). CONCLUSIONS: PFA allows rapid, safe, and effective ablation of surviving islands of myocardium within and around infarcted LV substrate. This technology holds promise for treating infarct-related ventricular tachycardia in humans.

Ostial dimensional changes after pulmonary vein isolation: Pulsed field ablation vs radiofrequency ablation.

BACKGROUND: Pulmonary vein (PV) stenosis is an important potential complication of PV isolation using thermal modalities such as radiofrequency ablation (RFA). Pulsed field ablation (PFA) is an alternative energy that causes nonthermal myocardial cell death. OBJECTIVE: The purpose of this study was to compare the effect of PFA vs RFA on the incidence and severity of PV narrowing or stenosis. METHODS: Data were analyzed from 4 paroxysmal atrial fibrillation ablation trials using either PFA or RFA; because of absent CT scans or poor computed tomography scan quality, 73 of 153 patients (47.7%) were excluded. Baseline and 3-month cardiac computed tomography scans were reconstructed into 3-dimensional images, and the long and short axes of the PV ostia were quantitatively and qualitatively assessed in a randomized blinded manner by 2 physicians. RESULTS: A total of 299 PVs from 80 patients after either PFA (n = 37) or RFA (n = 43) were enrolled. PV ostial diameters decreased significantly less with PFA than with RFA (% change; long axis: 0.9% ± 8.5% vs -11.9% ± 16.3%; P < .001 and short axis: 3.4% ± 12.7% vs -12.9% ± 18.5%; P < .001). After a combined quantitative/qualitative analysis, mild (30%-49%), moderate (50%-69%), or severe (70%-100%) PV narrowing was observed, respectively, in 9.0% (15 of 166), 1.8% (3 of 166), and 1.2% (2 of 166) of PVs in the RFA cohort but in none of the PVs after PFA (P < .001). Overall, PV narrowing/stenosis was present in 0% and 0% vs 12.0% and 32.5% of PVs and patients who underwent PFA and RFA, respectively. CONCLUSION: This study indicates that unlike after RFA, the incidence and severity of PV narrowing/stenosis after PV isolation is virtually eliminated with PFA.

Development of Electrochemical Methods to Enzymatically Detect Lactate and Glucose Using Imaginary Impedance for Enhanced Management of Glycemic Compromised Patients.

Lactate is an important biological marker that can provide valuable information for patients who have experienced a traumatic injury. Additionally, when coupled with glucose, the severity and likely prognosis of a traumatic injury can be determined. Because monitoring various markers proves useful in diagnosis and treatment of trauma patients, monitoring both glucose and lactate simultaneously may be especially useful for diabetic patients who have suffered a traumatic injury. Previously, using electrochemical impedance spectroscopy (EIS), a sensor capable of measuring two affinity-based biomarkers simultaneously was demonstrated using the biomarker's specific optimal frequency to develop a deconvolution algorithm, which allowed for the measurement of two biomarkers from a single signal. Herein, while developing an EIS lactate sensor, dual enzymatic biomarker detection of lactate and glucose via EIS was also attempted. Both biomarkers were validated individually with the lactate sensor being additionally validated on whole blood samples. The EIS lactate biosensor achieved a range of detection from 0 to 32 mM of lactate and the glucose sensor a range of 0-100 mg/dL of glucose, which are representative of the likely physiological ranges that trauma patients experience. However, the preliminary attempt of dual marker detection was unsuccessful due to suspected accumulation of reduced redox probe on the surface of the self-assembled monolayer (SAM). Individually, the optimal frequency of lactate was determined to be 69.75 Hz and that of glucose was determined to be 31.5 Hz. However, when combined onto one sensor, no discernable optimal frequency could be determined which again was suspected to be due to the accumulation of the reduced redox probe at the surface of the SAM.