Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Experimental methods D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-144 - Electrical Safety Limits Of Single Shot Irreversible Electroporation Ablation To Prevent Arcing (ID 1210)

 R. Van Es: Nothing relevant to disclose.


Background: Irreversible electroporation (IRE) is a promising non-thermal technology for cardiac ablation. With single shot circular IRE, a large direct current is applied between a circular multi-electrode catheter and a skin patch. When a too large direct current is applied, gas formation at the catheter electrodes can lead to an electrically isolating bubble around the electrodes. If the remaining electrical field is strong enough, electrical breakdown of the gasses will occur, this is called arcing. Arcing can lead to barotrauma and the formation of large gas bubbles in the blood stream and should be avoided.
Objective: Determine the electrical limits for the non-arcing cardiac application of IRE.
Methods: In three 60-75 kg pigs, a 7F circular 14-electrode catheter with an adjustable hoop diameter of 16-27 mm was positioned floating in the left atrium. Cathodal IRE pulses with energies of 200-300J were delivered using a Lifepak 9 defibrillator. A variable series resistor was added to allow variation in voltage and current. Voltage and current waveforms were captured and blindly analyzed for waveform distortions consistent with arcing.
Results: A total of 116 IRE-pulses were delivered, of which 53 IRE-pulses were marked as arcing and 53 IRE-pulses were marked as non-arcing. Arcing thresholds for the 16 and 27-mm hoop were 36A and 45A, respectively.
Conclusion: Clear peak current limits were found below which arcing does not occur. It is important to take the used catheter hoop size (16 to 27 mm) into account when delivering IRE-pulses.