HRS 2018 Roundup: Researchers highlight the latest in cardiac ablation tech

There are lots of new opportunities in ablation, evidenced by the research touted at this year’s annual meeting of the Heart Rhythm Society in Boston.

Scientists presented data from trials evaluating cardiac ablation via pulsed electric fields, intramural needle ablation and more. Editors at MassDevice.com asked leading cardiac electrophysiologist Dr. Vivek Reddy, will there someday be one catheter to rule them all?

“As in most things, there will always be several,” he explained. Here’s a look at some of the ablation technology presented at this year’s meeting.

Intramural needle ablation for stubborn ventricular arrhythmia – 

Using an irrigated needle ablation catheter from Johnson & Johnson‘s (NYSE:JNJ) Biosense Webster, researchers evaluated safety and 6-month efficacy outcomes for patients with refractory ventricular arrhythmia.

Currently-available ablation technologies are not designed to work in the ventricular space, Reddy said. This trial aimed to evaluate Biosense’s device in 31 patients who have not responded to standard catheter ablation or antiarrhythmic drugs.

The researchers selected target sites based on endocardial mapping and then deployed the 27-gauge needle up to 10mm into the myocardium for recording and pace-mapping. Then, the scientists irrigated with contrast/saline for RF ablation, with current titrated to a maximum needle temperature of 60^oC, they said.

“All of the patients had failed using a standard approach and then using the needle we were able to get rid of their tachycardia,” Reddy explained. “So I think the technology is very exciting. The fact that it works gives physicians an alternative.”

Atrial fibrillation ablation using pulsed electric fields moves into the clinic – 

At this year’s HRS meeting, researchers presented the first clinical data from atrial fibrillation ablation with pulsed electric fields – a method known as electroporation, in which pulsed electric field energy ablates by creating tiny pores in cell membranes.

The team touted the procedure as “highly tissue selective,” noting that it could help avoid ablation of non-target tissues like the esophagus and the phrenic nerve.

“There is some degree of selectivity that we don’t have with other technologies. That’s the first exciting thing, but the second most exciting thing is this is not thermal ablation. So, it’s not an energy source that either heats or cools tissue. You’re basically punching holes in membranes, in the order of milliseconds,” Reddy said. 

PEF ablation was performed on 22 patients using customized catheters from Iowa Approach. Although the company does not yet have long-term data, Reddy said that acute data suggests the procedure performs well. There were no complications, according to the researchers, and the total procedure time averaged 67 (+/-10) minutes.

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