Effects of Contact Force on Lesion Size During Pulsed Field Catheter Ablation: Histochemical Characterization of Ventricular Lesion Boundaries

Author:

Nakagawa Hiroshi1ORCID,Castellvi Quim2ORCID,Neal Robert3ORCID,Girouard Steven3ORCID,Laughner Jacob3ORCID,Ikeda Atsushi4ORCID,Sugawara Masafumi1ORCID,An Yoshimori1ORCID,Hussein Ayman A.1ORCID,Nakhla Shady1ORCID,Taigen Tyler1ORCID,Srounbek Jakub1ORCID,Kanj Mohamed1,Santangeli Pasquale1ORCID,Saliba Walid I.1ORCID,Ivorra Antoni2ORCID,Wazni Oussama M.1ORCID

Affiliation:

1. Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., Y.A., A.A.H., S.N., T.T., J.S., M.K., P.S., W.I.S., O.M.W.).

2. Department of Information and Communications Technologies, Universitat Pompeu Fabra, Barcelona, Spain (Q.C., A. Ivorra).

3. Galvanize Therapeutics, Inc, Redwood City, CA (R.N., S.G., J.L.).

4. Department of Cardiology, Nihon University, Tokyo, Japan (A. Ikeda).

Abstract

Background: Effects of contact force (CF) on lesion formation during pulsed field ablation (PFA) have not been well validated. The purpose of this study was to determine the relationship between average CF and lesion size during PFA using a swine-beating heart model. Methods: A 7F catheter with a 3.5-mm ablation electrode and CF sensor (TactiCath SE, Abbott) was connected to a PFA system (CENTAURI, Galvanize Therapeutics). In 5 closed-chest swine, biphasic PFA current was delivered between the ablation electrode and a skin patch at 40 separate sites in right ventricle (28 Amp) and 55 separate sites in left ventricle (35 Amp) with 4 different levels of CF: (1) low (CF range of 4–13 g; median, 9.5 g); (2) moderate (15–30 g; median, 21.5 g); (3) high (34–55 g; median, 40 g); and (4) no electrode contact, 2 mm away from the endocardium. Swine were sacrificed at 2 hours after ablation, and lesion size was measured using triphenyl tetrazolium chloride staining. In 1 additional swine, COX (cytochrome c oxidase) staining was performed to examine mitochondrial activity to delineate reversible and irreversible lesion boundaries. Histological examination was performed with hematoxylin and eosin and Masson trichrome staining. Results: Ablation lesions were well demarcated with triphenyl tetrazolium chloride staining, showing (1) a dark central zone (contraction band necrosis and hemorrhage); (2) a pale zone (no mitochondrial activity and nuclear pyknosis, indicating apoptosis zone); and a hyperstained zone by triphenyl tetrazolium chloride and COX staining (unaffected normal myocardium with preserved mitochondrial activity, consistent with reversible zone). At constant PFA current intensity, lesion depth increased significantly with increasing CF. There were no detectable lesions resulting from ablation without electrode contact. Conclusions: Acute PFA ventricular lesions show irreversible and reversible lesion boundaries by triphenyl tetrazolium chloride staining. Electrode-tissue contact is required for effective lesion formation during PFA. At the same PFA dose, lesion depth increases significantly with increasing CF.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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