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Cardiac impact of R-wave triggered irreversible electroporation therapy

  • Author Footnotes
    1 Dr. Kostrzewa and Dr. Tueluemen contributed equally to this paper.
    Michael Kostrzewa
    Correspondence
    Address reprint requests and correspondence: Dr. med. Michael Kostrzewa, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
    Footnotes
    1 Dr. Kostrzewa and Dr. Tueluemen contributed equally to this paper.
    Affiliations
    Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Author Footnotes
    1 Dr. Kostrzewa and Dr. Tueluemen contributed equally to this paper.
    Erol Tueluemen
    Footnotes
    1 Dr. Kostrzewa and Dr. Tueluemen contributed equally to this paper.
    Affiliations
    DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Boris Rudic
    Affiliations
    DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Nils Rathmann
    Affiliations
    Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Ibrahim Akin
    Affiliations
    DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Thomas Henzler
    Affiliations
    Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Volker Liebe
    Affiliations
    DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Stefan O. Schoenberg
    Affiliations
    Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Martin Borggrefe
    Affiliations
    DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Steffen J. Diehl
    Affiliations
    Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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  • Author Footnotes
    1 Dr. Kostrzewa and Dr. Tueluemen contributed equally to this paper.

      Background

      Irreversible electroporation (IRE) is a novel tumor ablative therapy technique, using electric fields to induce apoptosis in target tissues. Whether these electric pulses of high field strength can cause cardiac damage and/or ablation-induced arrhythmias is unclear.

      Objective

      The purpose of this study was to systematically evaluate the safety of electrocardiogram (ECG)-gated IRE with regard to cardiac side effects.

      Methods

      In all patients, 12-lead ECG and signal-averaged ECG (SAECG) recordings were performed before and after IRE and 24-hour Holter recording on the day of the IRE procedure. Venous blood samples (N-terminal pro–brain-type natriuretic peptide [NT-proBNP], high-sensitive troponin I [hsTnI]) were obtained before and 4 and 16 hours after the procedure. Patients with abnormal findings were reevaluated after 3 months.

      Results

      In total, 26 patients with an oncologic indication for IRE (11 females, mean age 62.9 years) were prospectively enrolled. Nine patients (34.6%) showed an increase in hsTnI and 21 patients (80.8%) an increase in NT-proBNP after ablation. Fifteen patients (57%) developed arrhythmias related to the procedure. One patient, in whom hsTnI and NT-proBNP had increased, developed multiple, nonsustained ventricular tachycardia events. In another patient, atrial fibrillation was triggered twice in 2 separate procedures. Twelve patients had clinically benign arrhythmias. SAECG was negative in all patients.

      Conclusion

      Subclinical myocardial injury and nonfatal cardiac arrhythmias can occur in the context of IRE treatment. Although no sustained cardiac injuries could be found at 3-month follow-up, we propose implementation of a cardiac safety algorithm consisting of cardiac biomarkers and ECG monitoring when IRE is conducted.

      Keywords

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      Linked Article

      • Irreversible electroporation: Proceed with caution
        Heart RhythmVol. 15Issue 12
        • Preview
          Electroporation is a biological phenomenon that was discovered in the 1960s.1,2 It is characterized by disruption of lipid membrane and creation of nanoscale aqueous pathways (electropores) in the cell membrane, resulting from the delivery of high-voltage electrical pulses. These effects of a strong electric field can last for seconds3,4 before the cell membrane recovers and reseals the electropores. This ability of the cell membrane to reseal electropores is referred to as reversible electroporation and has been used for gene transfection5 (electrogenetherapy) and for introducing impermeable anticancer drugs in cells (electrochemotherapy).
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