Irreversible electroporation for catheter-based cardiac ablation: a systematic review of the preclinical experience
Irreversible electroporation (IRE) utilizing high voltage pulses is an emerging strategy for catheter-based cardiac ablation with considerable growth in the preclinical arena.
A systematic search for articles was performed from three sources (PubMed, EMBASE, and Google Scholar). The primary outcome was the efficacy of tissue ablation with characteristics of lesion formation evaluated by histologic analysis. The secondary outcome was focused on safety and damage to collateral structures.
Sixteen studies met inclusion criteria. IRE was most commonly applied to the ventricular myocardium (n = 7/16, 44%) by a LifePak 9 Defibrillator (n = 9/16, 56%), NanoKnife Generator (n = 2/16, 13%), or other custom generators (n = 5/16, 31%). There was significant heterogeneity regarding electroporation protocols. On histological analysis, IRE was successful in creating ablation lesions with variable transmurality depending on the electric pulse parameters and catheter used.
Preclinical studies suggest that cardiac tissue ablation using IRE shows promise in delivering efficacious, safe lesions.
KeywordsCardiac ablation Irreversible electroporation Pulsed electric field Atrial fibrillation Arrhythmias Catheter ablation Translational studies
Superior vena cava
D.M. would like to acknowledge that this study was conducted within the scope of the LEA EBAM: European Laboratory of Pulsed Electric Fields Applications in Biology and Medicine (2011–2018).
The study was in part funded by the Slovenian Research Agency (ARRS) through ARRS research programme—Electroporation-based technologies and treatments (P2-0249, 2015–2020).
Compliance with ethical standards
Conflict of interest
Authors SJA/SK/CW/CVD have filed but no issued patents within the realm of tools for electroporation. Author DM receives research funding and consulting fees from Medtronic. All other authors have no disclosures.
For studies by the authors as include in this review, all applicable international, national, and/or institutional guidelines for the care and use of animals were followed.
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