Optimizing Irreversible Electroporation Ablation with a Bipolar Electrode

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• 作者：Ayelet Wandel ; MD^a ; ^c ; Eliel Ben-David ; MD^a ; ^{elib@hadassah.org.il" class="auth_mail" title="E-mail the corresponding author} ; B. Said Ulusoy ; MD^a ; Robert Neal ; PhD^d ; Mohammad Faruja ; MD^b ; Isaac Nissenbaum ; BSc^a ; Svetlana Gourovich ; BSc^a ; S. Nahum Goldberg ; MD^a
• 关键词：IRE ; irreversible electroporation
• 刊名：Journal of Vascular and Interventional Radiology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：27
• 期：9
• 页码：1441-1450.e2
• 全文大小：2038 K

文摘

To optimize single-insertion bipolar irreversible electroporation (IRE) by characterizing effects of electric parameters and controlling tissue electric properties in a porcine model.

Materials and Methods

Single-insertion electrode bipolar IRE was performed in 28 in vivo pig livers (78 ablations). First, effects of voltage (2,700–3,000 V), number of pulses, repeated cycles (1–6 cycles), and pulse width (70–100 µs) were studied. Next, electric conductivity was altered by instillation of hypertonic and hypotonic fluids. Finally, effects of thermal stabilization were assessed using internal electrode cooling. Treatment effect was evaluated 2–3 hours after IRE. Dimensions were compared and subjected to statistical analysis.

Results

Delivering 3,000 V at 70 µs for a single 90-pulse cycle yielded 3.8 cm ± 0.4 × 2.0 cm ± 0.3 of ablation. Applying 6 cycles of energy increased ablation to 4.5 cm ± 0.4 × 2.6 cm ± 0.3 (P < .001). Further increasing pulse lengths to 100 µs (6 cycles) increased ablation to 5.0 cm ± 0.4 × 2.9 cm ± 0.3 (P < .001) but resulted in electric spikes and system crashes in 40%–50% of cases. Increasing tissue electric conductivity via hypertonic solution instillation in surrounding tissues increased frequency of generator crashes, whereas continuous instillation of distilled water eliminated this arcing phenomenon but reduced ablation to 2.3 cm ± 0.1. Controlled instillation of distilled water when electric arcing was suspected from audible popping produced ablations of 5.3 cm ± 0.6 × 3.1 cm ±0.3 without crashes. Finally, 3.1 cm ± 0.1 short-axis ablation was achieved without system crashes with internal electrode perfusion at 37°C versus 2.3 cm ± 0.1 with 4°C–10°C perfusion (P < .001).

Conclusions

Bipolar IRE ablation zones can be increased with repetitive high voltage and greater pulse widths accompanied by either judicious instillation of hypotonic fluids or internal electrode perfusion to minimize unwanted electric arcing.