Study on the process of cardiomyocyte apoptosis after pulsed field ablation

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Fan Zhang¹  Dongyan Wu¹  Wei Ma¹  Shaobo Fan¹  Le He¹  Fengmin Lu¹  Zhenxu Liu²  Siying Su²  Yanpeng Chen²  Yingjian Cui³  Zhixiao Xue³  Fenglin Jia³  Xinyu Xu³ 

[1] Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, China;Department of Research and Development, Tianjin Intelligent Health Medical Co., Ltd, Tianjin, China;School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China;

关键词: atrial fibrillation;    pulse field ablation;    pulmonary vein isolation;    cardiac ablation;    myocardiocyte;   

DOI  :  10.3389/fcvm.2023.1112131

 received in 2022-11-30, accepted in 2023-03-06,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundThe development of pulsed field ablation (PFA) as a new technique for pulmonary vein isolation (PVI) has been advancing rapidly in recent years. My team's previous work has shown the safety and long-term efficacy of bipolar asymmetric pulses in animal experiments. However, in ongoing clinical trials, we have observed that atrial fibrillation (AF) recurs in some patients after surgery, but the rhythm returns to normal without surgical intervention after seven days, and there is no recurrence in the follow-up.Based on this observation, we have proposed the hypothesis that myocardial cell apoptosis may play a role in AF recurrence after PFA. Our team has designed animal experiments to verify this hypothesis and further investigate the process of PFA-induced cardiomyocyte apoptosis.MethodsPulse field ablation was performed on 15 dogs and the animals were dissected at various time points after the operation (immediately, 3 days, 7 days, 30 days, and 150 days). To obtain ablation voltage maps, electroanatomic mapping was performed before and after ablation and before dissection. The ablation area was also subjected to HE and TUNEL staining to analyze apoptosis and pathological results.ResultsThe edge area of the ablation in the pulmonary vein (PV) demonstrated continuous dynamic changes from 0 to 2 h after the operation and a slight expansion of the ablation range was observed in the long-term follow-up. Myocardial intima hyperplasia was observed from 0 to 7 days. Local apoptosis was detected from 0 to 2 h and massive, concentrated apoptosis was observed at 3 days. No recurrence of apoptosis was seen at 7 days, 30 days, and 150 days.ConclusionsThe results of this study showed that after pulse field ablation (PFA), the central ablation area of the canine heart experienced immediate cardiomyocyte death. Meanwhile, cardiomyocytes in the edge ablation area underwent apoptosis, which began from 0 to 2 h post-operation and ended between 3 and 7 days. This process occurred simultaneously with intimal thickening.In the long-term follow-up group, there was no recovery of isolation and no recurrence of cardiomyocyte apoptosis, and no change was observed in the endomyocardial intima.

【 授权许可】

Unknown   
© 2023 Fan, Jia, Cui, Wu, He, Zhang, Xue, Xu, Lu, Ma, Su, Chen and Liu.