ヒグチ　サトシ   HIGUCHI Satoshi   樋口　諭    所属   医学部 医学科（東京女子医科大学病院）    職種   寄附部門講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Effect of Epicardial Pulsed Field Ablation Directly on Coronary Arteries.
掲載誌名	正式名：JACC. Clinical electrophysiology 略　 称：JACC Clin Electrophysiol ISSNコード：24055018/2405500X
掲載区分	国外
巻・号・頁	8(12),pp.1486-1496
著者・共著者	Higuchi Satoshi, Im Sung Il, Stillson Carol, Buck Eric D, Jerrell Samantha, Schneider Christopher W, Speltz Molly,, Gerstenfeld Edward P
発行年月	2022/12
概要	BACKGROUND:The unique tissue selectivity of pulsed field ablation (PFA) allows for minimizing collateral damage to the nerves/esophagus. However, the safety profile of epicardial PFA on coronary arteries (CAs) has not been well defined.OBJECTIVES:This study sought to evaluate the effect of epicardial PFA directly on CAs in a swine model.METHODS:In 4 swine, an 8-F linear quadripolar PFA catheter (FARAPULSE Inc) was introduced into the pericardial space via a subxiphoid puncture. After coronary angiography (Angio), QRS synchronized, biphasic, bipolar PFA was delivered directly on the left anterior descending artery, left circumflex artery, or normal myocardium (control) (2.0 kV × 4 applications per site). Angio was repeated immediately after ablation and repeated every 5 minutes to quantify the degree of CA narrowing. After 4- or 8-week survival, repeat Angio was performed followed by gross and histologic lesion analyses.RESULTS:A total of 15 lesions were delivered (8 left anterior descending arteries, 3 left circumflexes, and 4 controls). Target site Angio revealed median of 47% (IQR: 38%-69%) acute luminal narrowing immediately after PFA, which gradually resolved over 30 minutes. Epicardial PFA lesions extended into the myocardium with a median depth of 4.1 mm (IQR: 3.6-5.6 mm) passing across the CAs and adipose tissue. However, 87.5% of the CAs demonstrated minimal to mild CA stenosis associated with neointimal hyperplasia and tunica media fibrosis.CONCLUSIONS:In a swine model, epicardial PFA directly on CAs allowed the creation of myocardial lesions but led to a CA response characterized by acute moderate spasm and chronic mild stenosis via neointimal hyperplasia.
DOI	10.1016/j.jacep.2022.09.003
PMID	36779624