Pulsed electric field delivery successfully converted induced atrial fibrillation and flutter in swine models, achieving >70% conversion success at ≥1500V for RA/CS and ≥2000V for RA/epiLA setups.
Does pulsed electric field delivery convert induced atrial fibrillation and flutter in a swine model?
Pulsed electric field delivery is a feasible method for converting atrial arrhythmias in a preclinical swine model, providing proof-of-concept for reversible electroporation in rhythm control.
Abstract Background Many patients with atrial fibrillation (AF) suffer life-limiting symptoms and heart failure. Although enormous advances in rhythm control have been made, device-based therapies for treating recurrent episodes are limited. Using pulsed electric fields (PEF) to induce reversible electroporation of cardiac tissue may effectively terminate AF. Purpose To assess the feasibility of PEF delivery for converting atrial arrhythmias via reversible electroporation. Methods Four swine models were used in this acute study. Custom-made decapolar catheters for PEF delivery were deployed with the following configurations: 1. Endocardial right atrium (RA) and coronary sinus (CS), n=2; 2. Endocardial RA and epicardial left atrium (epiLA), n=2. AF and atrial flutter (AFL) were induced with programmed stimulation. PEF delivery was performed using the BTX 830 generator. For each attempt, a single monophasic pulse at 10 or 20µs pulse width was administered, with voltage varied across attempts (range 750-3000V). Successful (type 1 and 2 breaks) and unsuccessful conversion attempts were recorded. Post-PEF signal changes and arrhythmias were identified. Results A total of 58 AF/AFL (28 and 30 respectively) episodes were induced. Of the 37 successful conversion attempts, 33 (89.1%) were type 1 breaks. Conversion success probabilities generally increased with higher voltages for both configurations. 70% conversion success was seen with ≥1500V for the RA/CS configuration and ≥2000V for the RA/epiLA configuration. Arrhythmias including intra-atrial delay and high-grade atrioventricular block were seen, usually following successive PEF deliveries. Significant muscle stimulation was provoked with the current experimental setup. Conclusion Termination of atrial arrhythmias with PEF delivery is feasible, although further work is required to optimize its efficacy and safety.
Tan et al. (2025) studied Atrial fibrillation and flutter (n=4). Pulsed electric field (PEF) delivery was evaluated on Successful conversion of atrial arrhythmias (type 1 and 2 breaks). Pulsed electric field delivery successfully converted induced atrial fibrillation and flutter in swine models, achieving >70% conversion success at ≥1500V for RA/CS and ≥2000V for RA/epiLA setups.