X-ray image of the catheter introduced into the pulmonary veins as far as the foci to be destroyed by electroporation.Photo DR.
High-voltage electrical impulses applied for a few seconds to open pores in the membranes of targeted heart cells and destroy them: the Arnault-Tzanck Institute, in Saint-Laurent-du-Var, is one of the first establishments in France to s be equipped with this very promising new technique for treating atrial or atrial fibrillation (AF, read below). Update on electroporation ablation with Dr Claude Mariottini, interventional cardiologist at the institute.
For who?
This technique is used to treat patients with paroxysmal atrial fibrillation. This very frequent arrhythmia (more than 1% of the population concerned) manifests itself in the form of transient acute attacks; it is one of the leading causes of stroke in Europe.
Comment?
Knowing that arrhythmia is linked to abnormal electrical foci in the left atrium (one of the two small upper chambers of the heart collecting oxygenated blood arriving from the lungs), the goal of electroporation treatment is to destroy these foci . To do this, a catheter is introduced into the four pulmonary veins which open into the left atrium, and when the target is reached, a pulsed electrical current is sent for 4 seconds to the level of the cardiac electrical cells which are dysfunctional.
What advantages?
Faster (30 to 45 minutes less than other techniques), electroporation ablation also eliminates the rare risk – but feared by cardiologists – of extra-cardiac complications, thanks to extremely precise targeting of the area treat. The esophagus and the phrenic nerves which pass behind the heart (essential for respiratory movements) are thus totally preserved.
In what conditions?
These procedures are performed under general anesthesia; they currently require hospitalization, but should soon be performed on an outpatient basis.
What efficiency?
The results are as good as with the other techniques. Post-ablation recurrence by electroporation is estimated at less than 10%.
What limits?
The limits are related to general anesthesia. Generally, patients over 80 years of age are not treated with electroporation unless they are in good physiological condition.
