How the ablation of cardiac arrhythmias works?

Cardiac electroporation is one of the ablation procedures available today. It is the most state-of-the-art and minimally invasive methodology introduced for the treatment of conditions such as:

• atrial fibrillation, a heart condition characterized by an irregular and rapid atrial rhythm;
• atrial flutter, an arrhythmia affecting the atria of the heart.

“Cardiac electroporation is used for the treatment of atrial arrhythmias, i.e. those disorders linked to the rhythm and frequency of the heart that originate in the cardiac atria,” Doctor Mantica specifies. “It is possible in the future to hypothesize extending the field of action of this technique to other types of tachycardias of ventricular origin”.

It is a minimally invasive procedure that acts selectively on cardiac tissue, with the advantage of safeguarding the endothoracic structures close to it.

Cardiac electroporation involves the application of a very intense, short-duration electrical pulse to the areas of the heart responsible for rhythmic abnormalities. Electrical energy is delivered through an irrigated multipolar catheter placed within the left cardiac atrium. Using high-voltage pulses for a few seconds induces in the heart cells the formation of holes in the cell membrane resulting in instantaneous necrosis of the pathological cells and source of the arrhythmia.       

Compared to traditional methodologies, electroporation, through the use of these impulses which act only on targeted points, presents itself as an energy: 

• more selective to the myocardial tissue itself;
• less injurious to structures surrounding the heart, such as nerves, esophagus, and blood vessels;
• with a lower risk of complications, due to tissue selectivity. 

In addition, this procedure has 30% shorter surgery times than traditional methods. 

Differences from thermoablation and cryoablation

Thus, cardiac electroporation has numerous advantages for the candidate patient over thermoablation and cryoablation methods. 

"These traditional thermal energies act in the heart by causing a thermally controlled injury by heating or cooling the cardiac tissue. These are widely known energies that are very effective, but they also involve the structures surrounding the heart in the ablative process; therefore, in some cases, it is possible to have side and undesirable effects, which are then the real complications of this procedure," the doctor specifies. 

The new electroporation methodology, on the other hand, is developed with the aim of making the ablative procedure as minimally invasive as possible, trying to reduce the risks associated with traditional methodologies."

The post-operative course of cardiac electroporation is comparable to previously used procedures (in the absence of complications). "In our hospital routinely the patient is discharged home on the second postoperative day, with no major limitations other than avoiding strenuous physical activity for 15-20 days," the specialist explains.

“The cardiac electroporation procedure can only be accessed by patients diagnosed with atrial fibrillation and atrial flutter. At the moment, patients with less complex fibrillations and in the absence of structural heart disease are subjected to it,” the specialist continues. “This indication is present because the electroporation technique can currently only be used in certain and specific portions of the heart”.

Subsequent to the indication by the electrophysiology specialist for cardiac ablation therapy, a clinical evaluation therefore takes place to determine the most suitable method.

"The clinical choice of ablative technique is the sole responsibility of the electrophysiology specialist who, only after a careful examination and analysis of clinical features, can determine the most suitable technique. For candidacy for the use of cardiac electroporation, the clinical profile of the individual patient is therefore evaluated, together with instrumental tests requested during the visit", the specialist concludes.