Characteristics of pulsed electric field cardiac ablation porcine treatment zones with a focal catheter

Abstract

Objectives Pulsed electric field (PEF) therapies employ punctuated energy delivery to kill cells in a volume of tissue through mechanisms that are not dependent on thermal processes. A key component to successful cardiac ablation procedures is ensuring the generation of transmural, contiguous ablation zones, which requires in‐depth knowledge regarding treatment sizes for a given therapeutic application. Methods In this study, a series of acute treatments were delivered to porcine ventricles, where triphenyl tetrazolium chloride (TTC) vitality stain was used to identify treatment effect sizes for the three focal monopolar CENTAURI PEF cardiac ablation energy settings. Results Treatment depths were 5.7, 7.2, and 8.2 mm for the 19, 22, and 25 A energy settings, respectively. Gross pathology indicated umbral zones of hemorrhage surrounded by pale avital TTC‐negative‐negative tissue, which contrasted significantly from radiofrequency ablation (RF) controls. Histologically, treatment zones are identified by regions of contraction band necrosis and cardiomyocytolysis, which contrasted with RF control lesions composed primarily of coagulation necrosis. Conclusions Together, these data indicate the ability for focal monopolar PEF treatments to generate deep treatment zones in cardiac ablation without incurring the gross or histological coagulative characteristics of RF thermal lesions.

Dynamics of High-Density Unipolar Epicardial Electrograms During PFA

“…For the highest dose applied, a central area of hemorrhage was systematically observed compatible with previous studies describing capillary endothelium disruption and erythrocyte extravasation. 12 Although applications were not synchronized with the cardiac cycle, no ventricular fibrillation was induced in any of the applications.…”

“…For the highest dose applied, a central area of hemorrhage was systematically observed compatible with previous studies describing capillary endothelium disruption and erythrocyte extravasation. 12…”

Pearls and Pitfalls of Pulsed Field Ablation

“…The estimated study completion date for both trials is April 2023. An interesting study in porcine ventricles pointed out that dose titration results in different lesion depths, e.g., the 25 A setting created the deepest lesion (8.2 mm), 73) which allows dose adaptation for different wall thicknesses of the heart and tailor ablation therapy even for indications beyond PVI. Figures 5 and 6 show the CENTAURI TM generator and a PVI procedure guided by 3D electroanatomical mapping.…”

Nonthermal Point-by-Point Pulmonary Vein Isolation Using a Novel Pulsed Field Ablation System

“…Recently, a novel PFA system (CENTAURI; Galvanize Therapeutics) was introduced that enables monopolar biphasic PFA with commercially available, contact force-sensing, solid-tip focal ablation catheters their associated 3-dimensional mapping systems. 4 The purpose of this observational study was to prospectively investigate the feasibility and safety of point-by-point PFA-based PVI using the novel PFA system.…”

“…Focal PFA applications-annotated by 6-mm diameter tags-were delivered with 20% overlap to secure continuous lesion formation (Figure ). 4 Real-time PV electrograms were obtained by the multipolar mapping catheter. After ablation, a left atrial remap was acquired and PVI was reconfirmed after a waiting period of 30 minutes.…”