Reversible Pulsed Electrical Fields as an In Vivo Tool to Study Cardiac Electrophysiology: The Advent of Pulsed Field Mapping

• DOI: 10.1161/circep.123.012018
• Publication Date: 2023-09-20T09:01:06Z
• Authors: Jacob S. Koruth; Petr Neuzil; Iwanari Kawamura; Kenji Kuroki; Jan Petru; Gediminas Rackauskas; Moritoshi Funasako; Audrius Aidietis; Vivek Y. Reddy
• Keywords: Cardiac Electrophysiology; Atrioventricular block; Atrioventricular node; Electrophysiology study

BACKGROUND: During electrophysiological mapping of tachycardias, putative target sites are often only truly confirmed to be vital after observing the effect ablation. This lack specificity potentiates inadvertent ablation innocent cardiac tissue not relevant arrhythmia. But if myocardial excitability could transiently suppressed at critical regions, their suitability as targets conclusively determined before delivering tissue-destructive lesions. We studied whether reversible pulsed electric fields (PF REV ) suppress electrical conduction, thereby providing a means dissect tachycardia circuits in vivo. METHODS: PF energy was delivered from 9-mm lattice-tip catheter atria 12 swine and 9 patients, followed by serial electrogram assessments. The effects on conduction were explored 5 additional animals applying atrioventricular node: 17 low-dose REV-LOW 10 high-dose REV-HIGH applications. Finally, 3 patients manifesting spontaneous applied sites. RESULTS: In animals, immediate post-PF amplitudes diminished 74%, 78% recovery minutes. Similarly, 69.9% amplitude reduction 84% Histology revealed minimal no focal, superficial fibrosis. node resulted transient PR prolongation AV block 59% 6%, while caused 30% 50%, respectively. had atypical atrial flutters (n=2) nodal reentrant tachycardia. reproducibly terminated tachycardias; rendered tachycardias noninducible without recurrence during 1-year follow-up. CONCLUSIONS: Reversible electroporation pulses can conduction. technique field may represent novel tool help identify isthmus circuits.