Pulsed Field Ablation Using a Lattice Electrode for Focal Energy Delivery

Author:

Yavin Hagai1ORCID,Shapira-Daniels Ayelet2ORCID,Barkagan Michael2,Sroubek Jakub2ORCID,Shim David2ORCID,Melidone Raffaele3,Anter Elad1ORCID

Affiliation:

1. Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.Y., E.A.).

2. Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (A.S.-D., M.B., J.S., D.S.).

3. Harvard-CBSET, Department of Pathology, Lexington, MA (R.M.).

Abstract

Background: Pulsed field ablation (PFA) is a nonthermal energy that may provide safety advantages over radiofrequency ablation (RFA). One-shot PFA catheters have been developed for pulmonary vein isolation, but they do not permit flexible lesion sets. This study investigated a novel lattice-tip catheter designed for focal RFA or PFA ablation. Methods: The effects of PFA (biphasic, 24 amperes) were investigated in 25 swine using a lattice-tip catheter and system (Affera Inc). Step 1 (n=14) examined the feasibility to create atrial line of block and described its acute effects on the phrenic nerve and esophagus. Step 2 (n=7) examined the subacute effects of PFA on block durability, phrenic nerve, and esophagus ≥2 weeks. Step 3 compared the effects of PFA and RFA on the esophagus using a mechanical deviation model approximating the esophagus to the right atrium (n=4) and by direct ablation within its lumen (n=4). The effects of endocardial PFA and RFA on the phrenic nerve were also compared (n=10). Histological analysis was performed. Results: PFA produced acute block in 100% of lines, achieved with 2.1 (1.3–3.2) applications/cm line. Histological analysis following (35 [18–37]) days showed 100% transmurality (thickness range 0.4–3.4 mm) with a lesion width of 19.4 (10.9–27.4 mm). PFA selectively affected cardiomyocytes but spared blood vessels and nervous tissue. PFA applied from the posterior atria (23 [21–25] applications) to the approximated esophagus (6 [4.5–14] mm) produced transmural lesions without esophageal injury. PFA (16.5 [15–18] applications) applied inside the esophageal lumen produced mild edema compared with RFA (13 [12–14] applications) which produced epithelial ulcerations. PFA resulted in no or transient stunning of the phrenic nerve (<5 minutes) without histological changes while RFA produced paralysis. Conclusions: PFA using a lattice-tip ablation catheter for focal ablation produced durable atrial lesions and showed lower vulnerability to esophageal or phrenic nerve damage compared with RFA.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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