Is electrocardiogram-gated irreversible electroporation still effective in liver ablation? A validation study in swine liver irreversible electroporation model

Abstract

Background : : To evaluate and compare the efficacy of tissue ablation in electrocardiogram (ECG)-synchronized and non-synchronized irreversible electroporation (IRE) ablation using radiological and histological analyses. Methods : : Five Yorkshire swine underwent 2,250 or 3,000 volt IRE ablation of multiple liver zones with high-rate, non-synchronized irreversible electroporation (nsIRE) pulses delivered at 240 pulses per minute (PPM) (n = 12) and ECG-synchronized irreversible electroporation (esIRE) pulses at either medium rate delivered at 50 PPM (n = 12) or low rate at 20 PPM (n = 6). We evaluated and compared the volume of ablation zones and IREinduced cell death between esIRE and nsIRE groups using radiological and histological analyses. Results : : In ultrasound examination, no significant difference was observed between the size of esIRE and nsIRE treated areas in all three dimensions (P = 0.93, 240 PPM vs. 50 PPM and P = 0.89, 240 PPM vs. 20 PPM). The ablation areas were also well-correlated in gross pathological analysis, with no significant difference between esIRE and nsIRE groups (P = 0.55, 240 PPM vs. 50 PPM and P = 0.56, 240 PPM vs. 20 PPM). Gross and microscopic examinations demonstrated complete cell death in both esIRE and nsIRE cohorts with preservation of large blood vessels and bile ducts in both groups. No cardiac dysrhythmia was noted in esIRE group. Conclusion : : In our study, no histological or radiological differences were observed between esIRE and nsIRE ablated areas. The esIRE ablation maintained its ability to create complete focal cell death.

Keywords

• electrocardiography; electroporation; liver