Electroporation systems being used to tackle a condition which one in four over-55s will develop
THE Blackrock Clinic recently started its new program of electroporation for the treatment of patients with atrial fibrillation.
Conventional catheter ablation for the treatment of cardiac arrhythmias uses tissue heating (radiofrequency current) to cauterize the targeted heart muscle. Such heating by conventional catheter ablation is a long established approach, but does carry a small risk of thermal injury outside the heart.
Recently developed electroporation systems achieve controlled cauterization of targeted heart muscle without significant tissue heating. Early results with this alternative energy source indicate there may be a lower associated risk of complications to surrounding organs in addition to a potentially higher acute procedural success rate.
The use of electroporation to effect targeted heart muscle can potentially offer more selective and controlled tissue effects than thermal ablation.
The mechanism of action of electroporation on heart muscle has been studied in experimental models since the 1990s. The delivery of a high energy single electric shock or a series of shocks in quick succession results in temporary pores in the cell membrane. These non-selective pores permit the entry and exit of compounds into the cell that would not usually be permitted to pass freely into or out of the cell.
If the energy delivered to tissue is around 100 Volts, then the effects on the cells may be temporary and the cell usually recovers. This controlled effect has been used to deliver therapeutic agents into the cells including chemotherapy in cancer cells as well as genetic codes in the form of segments of RNA or DNA.
If however higher energy delivered around 1000 Volts, then the effects are permanent and result in cell death. It is this higher energy delivery that is used in the catheter ablation treatment of cardiac arrhythmias.
A number of companies have been conducting research and development in relation to novel electroporation systems including Affera, Farapulse, Adagio, Kardium, Galaxy Medical, Medtronic, BioSense Webster and St. Jude Medical but there are many more at various stages of refinement.
The primary arrhythmia being treated thus far by electroporation techniques is atrial fibrillation (AF) – a serious heart condition affecting more and more Irish patients. AF is an irregular and often rapid heart rhythm, and its incidence increases significantly with age. If not treated properly, it can lead to complications including stroke or heart failure.
With the prevalence of AF in Ireland on course to triple in the next two decades, the director of the cardiac electrophysiology service at the Blackrock Clinic, Professor David Keane, says that this new technology will allow for improved treatment for the Clinic’s patients.
“By using electroporation, we can more effectively target the source of the heart rhythm problem with a lower risk of thermal injury to collateral structures. This has obvious advantages when it comes to improved patient safety, which is particularly important for patients who have been afflicted by AF for a longer period of time,” he said.
“Data from the Irish Longitudinal Study on Aging suggests that 3.2% of Irish people over the age of 50 have AF, and as the population ages, we are on course to see the number of AF patients here reach 107,000 by 2040. To treat these patients effectively, we need to have the best tools available, and the recent launch of electroporation techniques here in the Blackrock Clinic will be a major addition,” Professor Keane added.
This April, Professor Keane carried out the first electroporation procedures of patients in the hospital using a multielectrode array catheter. Due to how recently it has been developed, the technology has yet to be deployed in many countries and regions, and Blackrock Clinic’s console is estimated to be one of a limited number of these devices in Europe.
Its introduction marks another milestone in Blackrock Clinic’s cardiology services following on from the launch of the ultra low temperature Adagio device with a concomitant oesophageal warming balloon earlier this year.
As the hospital continues construction work on its third dedicated EP cath lab (scheduled to be in operation by November) the Blackrock Clinic’s CEO James O’Donoghue said that these developments would help to meet the growing need for AF treatment in Ireland.
“A core part of our vision – and that of the Blackrock Health group of which we are part – is to bring cutting-edge treatments within reach of Irish patients, by making the very best tools available to our world-class medical teams.
“The development of the extra dedicated EP cath lab will help us to meet the needs of Irish patients experiencing this and other conditions, and we look forward to playing a major role in responding to this challenge,” O’Donoghue concluded.
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