Irreversible electroporation (IRE) is an upcoming nonthermal ablation technology used for atrial fibrillation (AF) patients for performing pulmonary vein (PV) isolation. The data obtained previously suggests that IRE ablation produces large enough lesions without the risk of PV stenosis, esophageal, nerve, or artery damage. This study aimed to investigate single pulse IRE PV isolation’s feasibility and safety in patients with AF.

Ten patients under general anesthesia, suffering from persistent or symptomatic paroxysmal AF received single pulse IRE PV isolation. Electroanatomical voltage mapping 3-D reconstruction of the PVs and left atrium were performed using a conventional circular mapping catheter. PV isolation was carried out by delivering nonbarotraumatic 6 ms, 200 J direct current IRE applications, through a custom 14-polar circular IRE ablation catheter. A deflectable sheath (Abbott, Agilis) was used to maneuver the ablation catheter. Adenosine testing (of 30 mg) was used to unveil dormant PV conduction after a waiting period of 30-mins. Acute bidirectional electrical PV isolation was finally achieved by single-pulse IRE ablation.

In conclusion, single-pulse IRE ablation is a promising new technique that allows rapid and safe PV isolation. Ablation took only a few milliseconds, and the nonthermal tissue and character specificity of IRE ablation avoided most complications that are associated with  cryoablation and thermally mediated radiofrequency.