A novel method for septal reduction therapy by 3D-guided transvenous intra-septal pulse field ablation.
Hypertrophic obstructive cardiomyopathy
Myocardial-specific death
Pulse field ablation
Regulated cell death
Septal reduction therapy
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
24 Nov 2023
24 Nov 2023
Historique:
received:
08
04
2023
revised:
15
11
2023
accepted:
20
11
2023
medline:
27
11
2023
pubmed:
27
11
2023
entrez:
26
11
2023
Statut:
aheadofprint
Résumé
Pulsed field ablation (PFA) is a nonthermal method to achieve selective cell death with little inflammation response. However, there are no reports in septal reduction therapy (SRT). The study was aimed to investigate the effectiveness and safety of PFA for SRT. A novel transvenous intra-septal PFA method with 3-dimensional (3D) guidance was introduced in Yorkshire pigs. Electrocardiographic parameters, transthoracic echocardiography and histopathology were used to evaluated. The maximum injury diameter of intra-myocardial PFA increased with the electric field intensity. After PFA, the bipolar electrogram amplitude and pacing threshold measured by the PFA electrodes significantly decreased (F=6.945, P = 0.007) or increased (F=5.842, P=0.024), respectively. In the ablated septal region, the motion amplitude and the systolic wall thickening rate significantly decreased and remained at a low level (motion amplitude: F = 20.793, P = 0.000; systolic wall thickening rate: F = 14.343, P =0.000); however, the septal thickness did not significantly change after PFA (F =1.503, P = 0.248). Histological examination showed specific cardiomyocyte death with gradually increased hyperchromatic cytoplasm and nuclear pyknosis, without obvious inflammatory cell infiltration in acute phase. TUNEL stain for fragmented DNA showed wildly positive in ablation region at 24h after PFA. During PFA, no sustained ventricular arrhythmia or atrioventricular conduction block occurred. A novel intra-septal PFA method with 3D guidance was described. The intra-septal PFA resulted in effective myocardium injury and local hypokinesis without significant acute edema. Histological examination showed widely programmed cardiomyocyte death with little inflammatory cell infiltration.
Sections du résumé
BACKGROUND
BACKGROUND
Pulsed field ablation (PFA) is a nonthermal method to achieve selective cell death with little inflammation response. However, there are no reports in septal reduction therapy (SRT).
OBJECTIVE
OBJECTIVE
The study was aimed to investigate the effectiveness and safety of PFA for SRT.
METHODS
METHODS
A novel transvenous intra-septal PFA method with 3-dimensional (3D) guidance was introduced in Yorkshire pigs. Electrocardiographic parameters, transthoracic echocardiography and histopathology were used to evaluated.
RESULTS
RESULTS
The maximum injury diameter of intra-myocardial PFA increased with the electric field intensity. After PFA, the bipolar electrogram amplitude and pacing threshold measured by the PFA electrodes significantly decreased (F=6.945, P = 0.007) or increased (F=5.842, P=0.024), respectively. In the ablated septal region, the motion amplitude and the systolic wall thickening rate significantly decreased and remained at a low level (motion amplitude: F = 20.793, P = 0.000; systolic wall thickening rate: F = 14.343, P =0.000); however, the septal thickness did not significantly change after PFA (F =1.503, P = 0.248). Histological examination showed specific cardiomyocyte death with gradually increased hyperchromatic cytoplasm and nuclear pyknosis, without obvious inflammatory cell infiltration in acute phase. TUNEL stain for fragmented DNA showed wildly positive in ablation region at 24h after PFA. During PFA, no sustained ventricular arrhythmia or atrioventricular conduction block occurred.
CONCLUSIONS
CONCLUSIONS
A novel intra-septal PFA method with 3D guidance was described. The intra-septal PFA resulted in effective myocardium injury and local hypokinesis without significant acute edema. Histological examination showed widely programmed cardiomyocyte death with little inflammatory cell infiltration.
Identifiants
pubmed: 38008368
pii: S1547-5271(23)02967-3
doi: 10.1016/j.hrthm.2023.11.020
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023. Published by Elsevier Inc.