Cardiac impact of R-wave triggered irreversible electroporation therapy.
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.
['Kostrzewa|Michael|M|', 'Tueluemen|Erol|E|', 'Rudic|Boris|B|', 'Rathmann|Nils|N|', 'Akin|Ibrahim|I|', 'Henzler|Thomas|T|', 'Liebe|Volker|V|', 'Schoenberg|Stefan O|SO|', 'Borggrefe|Martin|M|', 'Diehl|Steffen J|SJ|']
D001145:Arrhythmias, Cardiac D004562:Electrocardiography D053672:Electrochemotherapy D005260:Female D005500:Follow-Up Studies D005858:Germany D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D009369:Neoplasms D011446:Prospective Studies
Irreversible electroporation Arrhythmia High-sensitive troponin I Myocardial injury Cardiac safety algorithm Cardiac biomarker Electrocardiographic monitoring N-terminal pro–brain-type natriuretic peptide Tumor ablation