Аблация импульсным полем для изоляции легочных вен

Представлен обзор литературы по новой технологии интервенционного лечения фибрилляции предсердий - аблации импульсным полем. Описан механизм воздействия, гистологическая картина в тканях, нежелательные эффекты  при  применении  данной  технологии.  Проведен  анализ  катетеров  для  аблации  импульсным  полем  с оценкой клинического эффекта и профиля безопасности.

1. Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies. Nature reviews. Cardiology. 2021;18(3): 210-225. https://doi.org/10.1038/s41569-020-00451-x.

2. Bradley CJ, Haines DE. Pulsed field ablation for pulmonary vein isolation in the treatment of atrial fibrillation. J Cardiovasc Electrophysiol. 2020 Aug;31(8): 2136-2147. https://doi.org/10.1111/jce.14414.

3. Wittkampf FHM, van Es R, Neven K. Electroporation and its relevance for cardiac catheter ablation. JACC Clin Electrophysiol. 2018;4: 977-86. https://doi.org/10.1016/j.

4. Chang DC, Reese TS. Changes in membrane structure induced by electroporation as revealed by rapid‐freezing electron microscopy. Biophys J. 1990;58(1): 1‐12.

5. Lee EW, Wong D, Prikhodko SV, et al. Electron microscopic demonstration and evaluation of irreversible electroporation‐induced nanopores on hepatocyte membranes. J Vasc Interv Radiol. 2012;23(1): 107‐113.

6. Pansera F, Bordignon S, Bologna F, et al. Catheter ablation induced phrenic nerve palsy by pulsed field ablation-completely impossible? A case series. European heart journal. Case reports. 6(9): ytac361. https://doi.org/10.1093/ehjcr/ytac361.

7. Wittkampf FH, van Driel VJ, van Wessel H, et al. Feasibility of electroporation for the creation of pulmonary vein ostial lesions. J Cardiovasc Electrophysiol. 2011;22: 302-309. https://doi.org/10.1111/j.1540-8167.2010.01863.x.

8. Van Driel VJ, Neven, K, van Wessel H, et al. Low vulnerability of the right phrenic nerve to electroporation ablation. Heart Rhythm. 2015;12: 1838-1844. https://doi.org/10.1016/j.hrthm.2015.05.012.

9. Neven, K, Van Es, R, Van Driel, V, Van Wessel, H, Fidder, H, Vink, A, Doevendans, P, Wittkampf, F. Acute and long-term effects of full-power electroporation ablation directly on the porcine esophagus. Circ Arrhythmia Electrophysiol. 2017;10: e004672.

10. Van Driel VJHM, Neven KGEJ, Van Wessel H, et al. Pulmonary vein stenosis after catheter ablation electroporation versus radiofrequency. Circ Arrhythmia Electrophysiol. 2014;7: 734-738.

11. Reddy, VY, Koruth, J, Jais, P, Petru, J, Timko, F, Skalsky, I, Hebeler, R, Labrousse, L, Barandon, L, Kralovec, S, et al. Ablation of atrial fibrillation with pulsed electric fields: an ultra-rapid, tissue-selective modality for cardiac ablation. JACC Clin Electrophysiol. 2018;4: 987-995. https://doi.org/10.1016/j.jacep.2018.04.005.

12. Steiger NA, Romero, JE. Pulsed-field ablation: What are the unknowns and when will they cease to concern us? Journal of cardiovascular electrophysiology, 2022;33(7): 1489-1493. https://doi.org/10.1111/jce.15521.

13. Lavee J, Onik G, Mikus P, et al. A novel nonthermal energysource for surgical epicardial atrial ablation: irreversible electro-poration. Heart Surg Forum. 2007;10(2): E162‐E167.

14. Stewart MT, Haines DE, Verma A, et al. Intracardiac pulsed field ab-lation: Proof of feasibility in a chronic porcine model. Heart Rhythm. 2019;16(5): 754‐764.

15. Wittkampf FH, Van Driel VJ, Van Wessel H, et al. Feasibility ofelectroporation for the creation of pulmonary vein ostial lesions. J Cardiovasc Electrophysiol. 2011;22(3): 302‐309.

16. Witt CM, Sugrue A, Padmanabhan D, et al. Intrapulmonary vein ab-lation without stenosis: a novel balloon‐ based direct current elec-troporation approach. J Am Heart Assoc. 2018;7(14): e009575.

17. Hong J, Stewart MT, Cheek DS, et al. Cardiacablation via electroporation. Conf Proc IEEE Eng Med Biol Soc. 2009;2009: 3381‐3384.

18. Yavin HD, Higuchi K, Sroubek J, et al. Pulsed‐field ablation in ventricular myocardium using a focalcatheter: the impact of application repetition on lesion dimensions. Circ Arrhythm Electrophysiol. 2021;14: e010375.

19. Howard B, Verma A, Tzou W, et al. Effects of Electrode-Tissue Proximity on Cardiac Lesion Formation Using Pulsed Field Ablation. Circulation. Arrhythmia and electrophysiology. 2022;15(10): e011110. https://doi.org/10.1161/CIRCEP.122.011110.

20. Gallagher JJ, Svenson RH, Kasell JH, et al. Catheter technique forclosed‐chest ablation of the atrioventricular conduction system. N Engl J Med. 1982;306(4): 194‐200.

21. Scheinman MM. Catheter‐induced ablation of the atrioventricularjunction to control refractory supraventricular arrhythmias. JAMA. 1982;248(7): 851‐855.

22. Tekle E, Astumian RD, Chock PB. Electroporation by using bipolar oscillating electric field: an improved method for DNA transfection of NIH 3T3 cells. Proc Natl Acad Sci USA. 1991;88(10): 4230-4234. https://doi.org/10.1073/pnas.88.10.4230.

23. Chang DC. Cell poration and cell fusion using an oscillating electric field. Biophys J. 1989;56(4): 641-652. https://doi.org/10.1016/S0006-3495(89)82711-0.

24. Onik G, Mikus P, Rubinsky B. Irreversible electroporation: implications for prostate ablation. Technol Cancer Res Treat. 2007;6(4): 295-300. https://doi.org/10.1177/153303460700600405.

25. Арчаков ЕА, Баталов РЕ, Хлынин МС, и др. Электропорация миокарда - альтернатива термическим методам лечения фибрилляции предсердий. Рациональная Фармакотерапия в Кардиологии. 2023;19(3): 277-281. https://doi.org/10.20996/1819-6446-2023-2840.

26. Lavee J, Onik G, Mikus P, et al. A novel nonthermal energy source for surgical epicardial atrial ablation: irreversible electroporation. Heart Surg Forum. 2007;10(2): E162-E167. https://doi.org/10.1532/HSF98.20061202.

27. Hunter DW, Kostecki G, Fish JM, et al. In Vitro Cell Selectivity of Reversible and Irreversible: Electroporation in Cardiac Tissue. Circ Arrhythm Electrophysiol. 2021;14(4): e008817. https://doi.org/10.1161/CIRCEP.120.008817.

28. Reddy VY, Koruth J, Jais P, et al. Ablation of Atrial Fibrillation With Pulsed Electric Fields: An Ultra-Rapid, Tissue-Selective Modality for Cardiac Ablation. JACC Clin Electrophysiol. 2018;4(8): 987-995. https://doi.org/10.1016/j.jacep.2018.04.005.

29. Madhavan M, Venkatachalam KL, Swale MJ, et al. Novel percutaneousepicardial autonomic modulation in the canine for atrial fibrillation:results of an efficacy and safety study. Pacing Clin Electrophysiol. 2016;39(5): 407‐417.

30. Livia C, Sugrue A, Witt T, et al. Elimination of Purkinje fibers byelectroporation reduces ventricular fibrillation vulnerability. J AmHeart Assoc. 2018;7(15): e009070.2146.

31. Haines DE, Stewart MT, Ahlberg S, et al. Microembolism and catheterablation I: a comparison of irrigated radiofrequency andmultielectrode‐phased radiofrequency catheter ablation of pulmonaryvein ostia. Circ Arrhythm Electrophysiol. 2013;6(1): 16‐22.

32. Reddy VY, Neuzil P, Koruth JS, et al. Pulsed field ablation for pulmonary vein isolation in atrial fibrillation. J Am Coll Cardiol. 2019;74(3): 315‐326.

33. Reddy VY, Ekanem E. ftM-KI. Multi-national survey on the safety of the post-approval clinical use of pulsed field ablation in 17,000+ patients (MANIFEST-17K). AHA 2023. 2023.

34. Venier S, Vaxelaire N, Jacon P, et al. Severe acute kidney injury related to haemolysis after pulsed field ablation for atrial fibrillation. Europace. 2023;26(1): euad371. https://doi.org/10.1093/europace/euad371.

35. Schmidt B, Bordignon S, Neven K, et al. EUropean real-world outcomes with Pulsed field ablatiOn in patients with symptomatic atRIAl fibrillation: lessons from the multi-centre EU-PORIA registry. Europace. 2023;25(7): euad185. https://doi.org/10.1093/europace/euad185.

36. Reddy VY, Dukkipati SR, Neuzil P, et al. Pulsed Field Ablation of Paroxysmal Atrial Fibrillation: 1-Year Outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol. 2021;7(5): 614-627. https://doi.org/10.1016/j.jacep.2021.02.014.

37. Reddy VY, Anic A, Koruth J, et al. Pulsed field ablation in patients with persistent atrial fibrillation. J Am Coll Cardiol. 2020;76: 1068-80. https://doi.org/10.1016/j.jacc.2020.07.007.

38. Sanders P, Healy S, Emami M, et al. Initial clinical experience with the balloon-in-basket pulsed field ablation system: acute results of the VOLT CE mark feasibility study. Europace. 2024;26(5): euae118. https://doi.org/10.1093/europace/euae118.

39. Duytschaever M, De Potter T, Grimaldi M, et al. Paroxysmal Atrial Fibrillation Ablation Using a Novel Variable-Loop Biphasic Pulsed Field Ablation Catheter Integrated With a 3-Dimensional Mapping System: 1-Year Outcomes of the Multicenter inspIRE Study. Circulation. Arrhythmia and electrophysiology. 2023;16(3): e011780. https://doi.org/10.1161/CIRCEP.122.011780.

40. De Potter T, Grimaldi M, Duytschaever M, et al. Predictors of Success for Pulmonary Vein Isolation With Pulsed-field Ablation Using a Variable-loop Catheter With 3D Mapping Integration: Complete 12-month Outcomes From inspIRE. Circulation. Arrhythmia and electrophysiology. 2024;17(5): e012667. https://doi.org/10.1161/CIRCEP.123.012667.

41. Reddy VY, Calkins H, Mansour M, et al. Long‐term safety andeffectiveness after paroxysmal atrial fibrillation pulsed field ablationfrom the U.S. multicenter AdmIRE study presented at: the HeartRhythm Society Annual Meeting. 2024. May 16‐19; Boston, MA.

42. Verma A, Boersma L, Haines DE, et al. First-in-Human Experience and Acute Procedural Outcomes Using a Novel Pulsed Field Ablation System: The PULSED AF Pilot Trial. Circulation. Arrhythmia and electrophysiology. 2022;15(1): e010168. https://doi.org/10.1161/CIRCEP.121.010168.

43. Verma A, Haines DE, Boersma LV, et al. Pulsed Field Ablation for the Treatment of Atrial Fibrillation: PULSED AF Pivotal Trial. Circulation. 2023;147(19): 1422-1432. https://doi.org/10.1161/CIRCULATIONAHA.123.063988.

44. Ревишвили АШ, Кузнецов НМ, Артюхина ЕА, и др. Опыт применения системы необратимой электропорации для изоляции легочных вен у пациентов с фибрилляцией предсердий. Вестник аритмологии. 2026;33(1): 60-67. https://doi.org/10.35336/VA-1581.

45. Andrade JG, Champagne J, Dubuc M, et al. Cryoballoon or Radiofrequency Ablation for Atrial Fibrillation Assessed by Continuous Monitoring: A Randomized Clinical Trial. Circulation. 2019;140: 1779-1788.

46. Luik A, Radzewitz A, Kieser M, et al. Cryoballoon Versus Open Irrigated Radiofrequency Ablation in Patients with Paroxysmal Atrial Fibrillation. Circulation. 2015;132: 1311-1319.

47. Kuck KH, Brugada J, Fürnkranz A, et al. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N. Engl. J. Med. 2016;374: 2235-2245.

48. Ekanem E, Reddy VY, Schmidt B, et al. Multinational survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF). Europace. 2022;24: 1256-1266.

49. Pierucci N, Mariani MV, Laviola D, et al. Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications. Journal of clinical medicine. 2024;13(10): 2980. https://doi.org/10.3390/jcm13102980.

50. Hindricks G, Potpara T, Dagres N, et al. The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 2021;42: 373-498.

51. Kapur S, Barbhaiya C, Deneke T, et al. Esophageal Injury and Atrioesophageal Fistula Caused by Ablation for Atrial Fibrillation. Circulation. 2017;136: 1247-1255.

52. Davong B, Adeliño R, Delasnerie H, et al. Pulsed-Field Ablation on Mitral Isthmus in Persistent Atrial Fibrillation Preliminary Data on Efficacy and Safety. JACC Clin. Electrophysiol. 2023;9: 1070-1081.

53. Reddy VY, Gerstenfeld EP, Natale A, et al. Pulsed Field or Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation. The New England journal of medicine. 2023;389(18): 1660-1671. https://doi.org/10.1056/NEJMoa2307291.

54. Reddy VY, Mansour M, Calkins H, et al. Pulsed Field vs Conventional Thermal Ablation for Paroxysmal Atrial Fibrillation: Recurrent Atrial Arrhythmia Burden. Journal of the American College of Cardiology. 2024;84(1): 61-74.