Naslov
Investigation of safety for electrochemotherapy and irreversible electroporation ablation therapies in patients with cardiac pacemakers

Autori
Jarm, Tomaz ; Krmac, Tadej ; Magjarevic, Ratko ; Kos, Bor ; Cindric, Helena ; Miklavcic, Damijan

Izvornik
Biomedical engineering online (1475-925X) 19 (2020), 1; 85, 18

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
Electrochemotherapy of tumors, Irreversible electroporation, Non-thermal ablation therapy, Cardiac pacemaker, Implantable devices, Safety, Numerical modeling, Experimental work

Sažetak
Background: The efectiveness of electrochemotherapy of tumors (ECT) and of irreversible electroporation ablation (IRE) depends on diferent mechanisms and delivery protocols. Both therapies exploit the phenomenon of electroporation of the cell membrane achieved by the exposure of the cells to a series of high- voltage electric pulses. Electroporation can be fne-tuned to be either reversible or irreversible, causing the cells to either survive the exposure (in ECT) or not (in IRE), respectively. For treatment of tissues located close to the heart (e.g., in the liver), the safety of electroporation-based therapies is ensured by synchronizing the electric pulses with the electrocardiogram. However, the use of ECT and IRE remains contraindicated for patients with implanted cardiac pacemakers if the treated tissues are located close to the heart or the pacemaker. In this study, two questions are addressed: can the electroporation pulses interfere with the pacemaker ; and, can the metallic housing of the pacemaker modify the distribution of electric feld in the tissue sufciently to afect the efectiveness and safety of the therapy? Results: The electroporation pulses induced signifcant changes in the pacemaker ventricular pacing pulse only for the electroporation pulses delivered during the pacing pulse itself. No residual efects were observed on the pacing pulses following the electroporation pulses for all tested experimental conditions. The results of numerical modeling indicate that the presence of metal- encased pacemaker in immediate vicinity of the treatment zone should not impair the intended efectiveness of ECT or IRE even when the casing is in direct contact with one of the active electrodes. Nevertheless, the contact between the casing and the active electrode should be avoided due to signifcant tissue heating at the site of the other active electrode for the IRE protocol and may cause the pulse generator to fail to deliver the pulses due to excessive current draw. Conclusions: The observed efects of electroporation pulses delivered in close vicinity of the pacemaker or its electrodes do not indicate adverse consequences for either the function of the pacemaker or the treatment outcome. These fndings should contribute to making electroporation-based treatments accessible also to patients with implanted cardiac pacemakers.

Izvorni jezik
Engleski

Znanstvena područja
Elektrotehnika, Interdisciplinarne tehničke znanosti

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