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Surgical Ablation of Cardiac Tissue with Nanosecond Pulsed Electric Fields in Swine

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Abstract

Background

Myocardial tissue can be ablated by the application nanosecond pulsed fields (nsPEFs). The applied electric fields irreversibly permeabilize cell membranes and thereby kill myocytes while leaving the extracellular matrix intact.

Methods

In domestic pigs (n = 10), hearts were exposed via sternotomy and either ablated in vivo (\(n\) = 5) or in excised, Langendorff-perfused hearts (\(n\) = 5). The nsPEFs consisted of 6–36 pulses of 300 ns each, delivered at 3–6 Hz; the voltage applied varied from 10 to 12 kV. Atrial lesions were either created after inserting the bottom jaw of the bipolar clamp into the atrium via a purse string incision (2–3 lesions per atrium) or by clamping a double layer of tissue at the appendages (one lesion per atrium). Ventricular lesions were created after an incision at the apex. The transmurality of each lesion was determined at three points along the lesion using a triphenyl tetrazolium chloride (TTC) stain.

Results

All 27 atrial lesions were transmural. This includes 13/13 purse string lesions (39/39 sections, tissue thickness 2.5–4.5 mm) and 14/14 appendage lesions (42/42 sections, tissue thickness 8–12 mm). All 3 right ventricular lesions were transmural (9/9 sections, 18 pulses per lesion). Left ventricular lesions were always transmural for 36 pulses (3/3 lesions, 9/9 sections). All lesions have highly consistent width across the wall. There were no pulse-induced arrhythmias or other complications during the procedure.

Conclusions

nsPEF ablation reliably created acute lesions in porcine atrial and ventricular myocardium. It has far better penetration and is faster than both radiofrequency ablation and cryoablation and it is free from thermal side effects.

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Conflict of interest

CZ holds stock in Pulse Biosciences.

Funding

This study was funded by a grant from Pulse Biosciences (Hayward, CA) to CZ.

Author information

Authors and Affiliations

  1. Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, VA, USA

    Frency Varghese, Johanna U. Neuber & Christian W. Zemlin

  2. Center for Bioelectrics, Old Dominion University, Norfolk, VA, USA

    Frency Varghese, Johanna U. Neuber, Barbara Hargrave & Christian W. Zemlin

  3. Department of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Frency Varghese

  4. Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA

    Jonathan M. Philpott

  5. Mid-Atlantic Thoracic Surgeons, Sentara Heart Hospital, Norfolk, VA, USA

    Jonathan M. Philpott

  6. Department of Biological Sciences, Old Dominion University, Norfolk, VA, USA

    Barbara Hargrave

  7. Division of Cardiothoracic Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO, 63110, USA

    Christian W. Zemlin

Authors
  1. Frency Varghese
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Correspondence to Christian W. Zemlin.

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Associate Editor Crystal Ripplinger oversaw the review of this article.

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Varghese, F., Philpott, J.M., Neuber, J.U. et al. Surgical Ablation of Cardiac Tissue with Nanosecond Pulsed Electric Fields in Swine. Cardiovasc Eng Tech 14, 52–59 (2023). https://doi.org/10.1007/s13239-022-00634-2

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  • DOI: https://doi.org/10.1007/s13239-022-00634-2

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