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Biophysical- and Engineering-Oriented Approaches to Energy-Based Cardiac Ablation Techniques
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Biophysical- and Engineering-Oriented Approaches to Energy-Based Cardiac Ablation Techniques

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Electrophysiology and Cardiovascular Physiology".

Deadline for manuscript submissions: closed (15 June 2024) | Viewed by 9813

Special Issue Editors

Dr. Ana González-Suárez

E-Mail Website
Guest Editor
School of Engineering, University of Galway, H91 TK33 Galway, Ireland
Interests: cardiac ablation; computational modeling; pulsed field ablation; radiofrequency; thermal ablation
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Erik B. Kulstad

E-Mail Website
Guest Editor
UT Southwestern Medical Center, Dallas, TX, USA
Interests: resuscitation; cardiac arrest; atrial fibrillation; medical devices
Dr. Juan J. Pérez

E-Mail Website
Guest Editor
BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, 46022 Valencia, Spain
Interests: cardiac ablation; computational modeling; radiofrequency; thermal ablation; bioimpedance
Dr. Ramiro Miguel Irastorza

E-Mail Website
Guest Editor
Instituto de Física de Líquidos y Sistemas Biológicos, Consejo Nacional de Investigaciones Científicas y Técnicas, La Plata B1900BTE, Argentina
Interests: dielectric and thermal properties of tissues; cardiac ablation; computational modeling; radiofrequency; thermal ablation

Special Issue Information

Dear Colleagues,

Despite the fact that ablative therapies based on electromagnetic energy are currently a minimally invasive option for treating some of the most common cardiac arrhythmias, there is still a lack of knowledge about the physical principles that govern the interaction between these energies and biological tissues. This applies to the well-known radiofrequency (RF) power as well as the more recent application of high-voltage pulses (pulsed field ablation), and includes others such as laser and microwave ablation. Therefore, this Special Issue will include new advances, perspectives, research and reviews of the biophysical mechanisms regarding these energy-based ablative techniques, aiming to improve our understanding of the physical principles underlying the use of electromagnetic energies to improve the safety and efficacy of the current treatments of cardiac arrhythmias. Although contributions are expected to have a significant engineering and physics component, as well as mathematical modeling, they should be sufficiently comprehensible and understandable to clinicians and physicians involved in the use of the aforementioned techniques.

Dr. Ana González-Suárez
Prof. Dr. Erik B. Kulstad
Dr. Juan J. Pérez
Dr. Ramiro Miguel Irastorza
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • cardiac ablation
  • radiofrequency ablation (RFA)
  • thermal ablation
  • pulsed field ablation (PFA)
  • microwave ablation (MWA)
  • laser ablation
  • thermal protection devices

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Published Papers (4 papers)

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Research

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12 pages, 2181 KiB  
Article
Ablation Parameters Predicting Pulmonary Vein Reconnection after Very High-Power Short-Duration Pulmonary Vein Isolation
by Márton Boga, Gábor Orbán, Zoltán Salló, Klaudia Vivien Nagy, István Osztheimer, Arnold Béla Ferencz, Ferenc Komlósi, Patrik Tóth, Edit Tanai, Péter Perge, Béla Merkely, László Gellér and Nándor Szegedi
J. Cardiovasc. Dev. Dis. 2024, 11(8), 230; https://doi.org/10.3390/jcdd11080230 - 24 Jul 2024
Viewed by 998
Abstract
Background: Recurrences due to discontinuity in ablation lines are substantial after pulmonary vein isolation (PVI) with radiofrequency ablation for atrial fibrillation. Data are scarce regarding the durability predictors for very high-power short-duration (vHPSD, 90 W/4 s) ablation. Methods: A total of 20 patients [...] Read more.
Background: Recurrences due to discontinuity in ablation lines are substantial after pulmonary vein isolation (PVI) with radiofrequency ablation for atrial fibrillation. Data are scarce regarding the durability predictors for very high-power short-duration (vHPSD, 90 W/4 s) ablation. Methods: A total of 20 patients were enrolled, who underwent 90 W PVI and a mandatory remapping procedure at 3 months. First-pass isolation (FPI) gaps, and acute pulmonary vein reconnection (PVR) sites were identified at the index procedure; and chronic PVR sites were identified at the repeated procedure. We analyzed parameters of ablation points (n = 1357), and evaluated their roles in predicting a composite endpoint of FPI gaps, acute and chronic PVR. Results: In total, 45 initial ablation points corresponding to gaps in the ablation lines were analyzed. Parameters associated with gaps were interlesion distance (ILD), baseline generator impedance, mean current, total charge, and loss of catheter–tissue contact. The optimal ILD cut-off for predicting gaps was 3.5 mm anteriorly, and 4 mm posteriorly. Conclusions: Biophysical characteristics dependent on generator impedance could affect the efficacy of vHPSD PVI. The use of smaller ILDs is required for effective and durable PVI with vHPSD compared to the consensus targets with lower power ablation, and lower ILDs for anterior applications seem necessary compared to posterior points. Full article
(This article belongs to the Special Issue Biophysical- and Engineering-Oriented Approaches to Energy-Based Cardiac Ablation Techniques)
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18 pages, 4301 KiB  
Article
The Effects of Interphase and Interpulse Delays and Pulse Widths on Induced Muscle Contractions, Pain and Therapeutic Efficacy in Electroporation-Based Therapies
by Aleksandra Cvetkoska, Alenka Maček-Lebar, Tamara Polajžer, Matej Reberšek, Weston Upchurch, Paul A. Iaizzo, Daniel C. Sigg and Damijan Miklavčič
J. Cardiovasc. Dev. Dis. 2023, 10(12), 490; https://doi.org/10.3390/jcdd10120490 - 7 Dec 2023
Cited by 6 | Viewed by 2241
Abstract
Electroporation is used in medicine for drug and gene delivery, and as a nonthermal ablation method in tumor treatment and cardiac ablation. Electroporation involves delivering high-voltage electric pulses to target tissue; however, this can cause effects beyond the intended target tissue like nerve [...] Read more.
Electroporation is used in medicine for drug and gene delivery, and as a nonthermal ablation method in tumor treatment and cardiac ablation. Electroporation involves delivering high-voltage electric pulses to target tissue; however, this can cause effects beyond the intended target tissue like nerve stimulation, muscle contractions and pain, requiring use of sedatives or anesthetics. It was previously shown that adjusting pulse parameters may mitigate some of these effects, but not how these adjustments would affect electroporation’s efficacy. We investigated the effect of varying pulse parameters such as interphase and interpulse delay while keeping the duration and number of pulses constant on nerve stimulation, muscle contraction and assessing pain and electroporation efficacy, conducting experiments on human volunteers, tissue samples and cell lines in vitro. Our results show that using specific pulse parameters, particularly short high-frequency biphasic pulses with short interphase and long interpulse delays, reduces muscle contractions and pain sensations in healthy individuals. Higher stimulation thresholds were also observed in experiments on isolated swine phrenic nerves and human esophagus tissues. However, changes in the interphase and interpulse delays did not affect the cell permeability and survival, suggesting that modifying the pulse parameters could minimize adverse effects while preserving therapeutic goals in electroporation. Full article
(This article belongs to the Special Issue Biophysical- and Engineering-Oriented Approaches to Energy-Based Cardiac Ablation Techniques)
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12 pages, 2648 KiB  
Article
A Predictive and an Optimization Mathematical Model for Device Design in Cardiac Pulsed Field Ablation Using Design of Experiments
by Eoghan Dunne, Jara M. Baena-Montes, Kevin Donaghey, Cormac Clarke, Marcin J. Kraśny, Bilal Amin, Tony O’Halloran, Leo R. Quinlan, Adnan Elahi and Martin O’Halloran
J. Cardiovasc. Dev. Dis. 2023, 10(10), 423; https://doi.org/10.3390/jcdd10100423 - 11 Oct 2023
Cited by 2 | Viewed by 1915
Abstract
Cardiac catheter ablation (CCA) is a common method used to correct cardiac arrhythmia. Pulsed Field Ablation (PFA) is a recently-adapted CCA technology whose ablation is dependent on electrode and waveform parameters (factors). In this work, the use of the Design of Experiments (DoE) [...] Read more.
Cardiac catheter ablation (CCA) is a common method used to correct cardiac arrhythmia. Pulsed Field Ablation (PFA) is a recently-adapted CCA technology whose ablation is dependent on electrode and waveform parameters (factors). In this work, the use of the Design of Experiments (DoE) methodology is investigated for the design and optimization of a PFA device. The effects of the four factors (input voltage, electrode spacing, electrode width, and on-time) and their interactions are analyzed. An empirical model is formed to predict and optimize the ablation size responses. Based on the ranges tested, the significant factors were the input voltage, the electrode spacing, and the on time, which is in line with the literature. Two-factor interactions were found to be significant and need to be considered in the model. The resulting empirical model was found to predict ablation sizes with less than 2.1% error in the measured area and was used for optimization. The findings and the strong predictive model developed highlight that the DoE approach can be used to help determine PFA device design, to optimize for certain ablation zone sizes, and to help inform device design to tackle specific cardiac arrhythmias. Full article
(This article belongs to the Special Issue Biophysical- and Engineering-Oriented Approaches to Energy-Based Cardiac Ablation Techniques)
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Review

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21 pages, 2880 KiB  
Review
Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation
by Barry O’Brien, John Reilly, Ken Coffey, Ana González-Suárez, Leo Quinlan and Martin van Zyl
J. Cardiovasc. Dev. Dis. 2023, 10(6), 238; https://doi.org/10.3390/jcdd10060238 - 29 May 2023
Cited by 9 | Viewed by 3623
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide. The cardiac autonomic nervous system (ANS) is widely recognized as playing a key role in both the initiation and propagation of AF. This paper reviews the background and development [...] Read more.
Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide. The cardiac autonomic nervous system (ANS) is widely recognized as playing a key role in both the initiation and propagation of AF. This paper reviews the background and development of a unique cardioneuroablation technique for the modulation of the cardiac ANS as a potential treatment for AF. The treatment uses pulsed electric field energy to selectively electroporate ANS structures on the epicardial surface of the heart. Insights from in vitro studies and electric field models are presented as well as data from both pre-clinical and early clinical studies. Full article
(This article belongs to the Special Issue Biophysical- and Engineering-Oriented Approaches to Energy-Based Cardiac Ablation Techniques)
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