Pulsed field ablation as a precise approach for cardiac arrhythmia treatment via cardiac microenvironment remodeling

Peng Teng; Yuefeng Wu; Ruoshi Chen; Liangjie Hong; Bin Wu; Lingshan Liu; Liang Ma; Haige Zhao; Shengjun Wu

doi:10.1016/j.bioelechem.2023.108502

Pulsed field ablation as a precise approach for cardiac arrhythmia treatment via cardiac microenvironment remodeling

Bioelectrochemistry. 2023 Dec:154:108502. doi: 10.1016/j.bioelechem.2023.108502. Epub 2023 Jul 4.

Authors

Peng Teng¹, Yuefeng Wu², Ruoshi Chen³, Liangjie Hong⁴, Bin Wu⁴, Lingshan Liu³, Liang Ma³, Haige Zhao⁵, Shengjun Wu⁶

Affiliations

¹ Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, 310003, China.
² Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China; The Lab of Biomed-X, Zhejiang University-University of Edinburgh Institute (ZJU-UoE), School of Medicine, Zhejiang University, Haining, 310000, China.
³ Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
⁴ Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, 310003, China.
⁵ Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China. Electronic address: haigezhao@zju.edu.cn.
⁶ Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, 310003, China. Electronic address: wsjsw@zju.edu.cn.

PMID: 37453203
DOI: 10.1016/j.bioelechem.2023.108502

Abstract

PFA uses short-duration, high-voltage electrical pulses to induce transient or irreversible electroporation on cell membranes, causing cell death. Selective inhibition of chaotic electrical signals in morbid cardiomyocytes significantly aids the treatment of atrial fibrillation, ventricular tachycardia, and other heart arrhythmias. Recent preclinical and clinical studies have only investigated physical changes, such as lesion size and myocardial scar. Compared to radiofrequency ablation and cryoballoon ablation, PFA causes less postoperative myocardial cell fibrosis and inflammatory reaction and does not result in myocardial necrosis or tissue scar formation. However, the regulatory mechanism of cellular stress following PFA treatment remains unknown. This study aimed to analyze the transcriptome of the mouse ventricle after PFA treatment. The animals were subjected to a 225-V electric pulse with a 1.5-mm gap between the positive and negative electrodes. Hearts were harvested at 3, 6, 12, 24 h, and 2, 5 days for myocardial zymogram testing. PFA-treated ventricular regions were selected for single-nucleus sequencing. We discovered that PFA remodeled the cardiac microenvironment as a whole. Further, we discussed the possible stress response and wound-healing mechanism in non-targeted cells. In conclusion, PFA allowed effective and selective ventricular myocardium ablation with controllable inflammation.

Keywords: Cardiac Arrhythmia; Cardiac Microenvironment; Pulsed Field Ablation; Wound healing.

MeSH terms

Animals
Atrial Fibrillation* / surgery
Catheter Ablation*
Cicatrix / surgery
Heart
Mice
Myocardium