Safety and efficacy aspects of pulsed field ablation catheters as a function of electrode proximity to blood and energy delivery method

Belalcazar, Andres

doi:10.1016/j.hroo.2021.10.004

Cited by 9 publications

(9 citation statements)

References 27 publications

(32 reference statements)

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“…The previous section shows significant differences in shape and fiber orientation at each ablation target; these two factors will lead to the difference in the electric field intensity distribution generated by PFA under the condition of the same electrical conductivity at each ablation target. Presently, a specific electric field intensity threshold is usually used to estimate whether PFA causes effective myocardial ablation [ 1 , 3 , 4 , 39 ]; this study used the IRE threshold for cardiac cells, which is defined as the electric field intensity exceeding 1000 V/cm [ 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…In the computational studies of PFA in AF treatment, to shorten the model construction process and reduce the computational complexity, the LA model is usually defined as a regular shape model such as a sphere [ 39 ] or a cylinder [ 41 ], and the fiber orientation is ignored; or the LA model is based on 3D medical imaging reconstruction [ 3 , 4 ] and the fiber orientation is ignored. Although Xie et al [ 1 ] constructed a myocardial model composed of multi-layer circular slabs and simulated fiber orientation by assigning an AC tensor to each layer, such regular fiber orientation still cannot reflect the influence of realistic fiber orientation on ablation characteristics in PFA in AF treatment consistently.…”

Section: Discussionmentioning

confidence: 99%

“…With the rapid development of PFA in AF treatment in recent years, several computational studies based on 3D medical imaging reconstruction combined with finite element analysis (FEA) have emerged to investigate the ablation characteristics generated by PFA in the pulmonary veins (PVs), in combination with experimental results [ 3 ] or comparing the safety and efficacy of different PFA catheters [ 4 ]. However, almost all relevant computational studies simplified the LA model to some extent to shorten the model construction process and reduce the computational complexity; one of the significant simplifications is to define the electrical conductivity of the LA model as isotropic electrical conductivity (IC).…”

Section: Introductionmentioning

confidence: 99%

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Effect of Anisotropic Electrical Conductivity Induced by Fiber Orientation on Ablation Characteristics of Pulsed Field Ablation in Atrial Fibrillation Treatment: A Computational Study

Zang

et al. 2022

JCDD

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Pulsed field ablation (PFA) is a promising new ablation modality for the treatment of atrial fibrillation (AF); however, the effect of fiber orientation on the ablation characteristics of PFA in AF treatment is still unclear, which is likely an essential factor in influencing the ablation characteristics. This study constructed an anatomy-based left atrium (LA) model incorporating fiber orientation and selected various electrical conductivity and ablation targets to investigate the effect of anisotropic electrical conductivity (AC), compared with isotropic electrical conductivity (IC), on the ablation characteristics of PFA in AF treatment. The results show that the percentage differences in the size of the surface ablation area between AC and IC are greater than 73.71%; the maximum difference in the size of the ablation isosurface between AC and IC at different locations in the atrial wall is 3.65 mm (X-axis), 3.65 mm (Z-axis), and 4.03 mm (X-axis), respectively; and the percentage differences in the size of the ablation volume are greater than 6.9%. Under the condition of the pulse, the amplitude is 1000 V, the total PFA duration is 1 s, and the pulse train interval is 198.4 ms; the differences in the temperature increase between AC and IC in LA are less than 2.46 °C. Hence, this study suggests that in further exploration of the computational study of PFA in AF treatment using the same or similar conditions as those used here (myocardial electrical conductivity, pulse parameters, and electric field intensity damage threshold), to obtain more accurate computational results, it is necessary to adopt AC rather than IC to investigate the size of the surface ablation area, the size of the ablation isosurface, or the size of the ablation volume generated by PFA in LA. Moreover, if only investigating the temperature increase generated by PFA in LA, adopting IC instead of AC for simplifying the model construction process is reasonable.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Anisotropic Electrical Conductivity Induced by Fiber Orientation on Ablation Characteristics of Pulsed Field Ablation in Atrial Fibrillation Treatment: A Computational Study

Zang

et al. 2022

JCDD

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“…Besides, in endocardial ablation, a multi-electrode system on the tip of a catheter has been found to be effective for creating long and continuous ablation zones. 19,20 In a simulation study, Belalcazar 21 discovered that the ablation depth can also be affected significantly by (1) the multielectrode structure configuration in one catheter and (2) the energy delivery method for the multi-electrode system.…”

Section: Introductionmentioning

confidence: 99%

“…In the present study, we further designed a novel polarity configuration for a multi-electrode system with the number of electrodes >2, called paired-electrode interlaced configuration (PIC), to increase the ablation depth of PFA as opposed to the existing configuration in the clinical setting (i.e., single-electrode interlaced configuration, SIC). 21,[23][24][25] The concept design and operating principle of the PIC are introduced in Section 2. In Section 3, a finite element model is developed to explore the mechanism of the PIC via simulation.…”

Section: Introductionmentioning

confidence: 99%

A novel polarity configuration for enhancing ablation depth of pulsed field ablation: Design, modeling, and in vivo validation

Fang

Yan

et al. 2023

Medical Physics

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BackgroundPulsed field ablation (PFA) has been increasingly used to cut off the delivery of abnormal electrical signals in the treatment of cardiac arrhythmias. A successful cut off requires forming a layer of transmural damage on the heart wall, and this layer depends on the depth of ablation by PFA.PurposeThis study aims to propose a novel polarity configuration of PFA to increase the ablation depth in the treatment of cardiac arrhythmias.MethodA novel polarity configuration was designed for a multi‐electrode system, where the number of electrodes is greater than two. The polarity configuration in such multi‐electrode system is called the paired‐electrode interlaced configuration (PIC). The existing configuration called the single‐electrode interlaced configuration (SIC) was used to compare with the PIC. To both the SIC and PIC, a full‐SIC or a full‐PIC is called when all electrodes (anode, cathode) in a catheter is used otherwise partial‐SIC or partial‐PIC is called. By the comparison between the full‐SIC and full‐PIC, the benefit of the PIC was exhibited as opposed to the SIC, but an extra ablation step was added in the PIC in order to form a continuous ablation zone. The other comparative study was taken between a partial‐PIC and a partial‐SIC with the same number of ablation step. In this study, a rabbit model was built by infusing 0.4% saline solution (at 37°C) into the rabbit's abdominal cavity which surrounds the liver. This model was considered as a biometric environment of the heart, namely cardiac‐mimetic model (CMM).ResultThe experimental results have shown that the full‐PIC is superior to the full‐SIC in the ablation depth, specifically in both the maximum (4.14 ± 0.55 mm vs. 3.35 ± 0.26 mm, p < 0.01) and the minimum (3.18 ± 0.29 mm vs. 2.76 ± 0.28 mm, p < 0.05), and in the ablation width, specifically only in the maximum (8.27 ± 0.76 mm vs. 7.09 ± 0.51 mm, p = 0.019) under an identical ablation time (i.e., 5 s). It is noted that the minimum ablation width did not show a significant difference between the full‐PIC and full‐SIC (specifically, 5.61 ± 0.86 mm vs. 4.67 ± 0.73 mm, p = 0.069). Considering the lethal electric field threshold (LEFT) to be 600 V/cm for liver tissues, the maximum and minimum ablation depth generated by the full‐PIC was found larger than that by the full‐SIC (3.90 vs. 3.52 mm, and 3.03 vs. 2.48 mm, respectively) in the simulation. Meanwhile, similar experiment results by comparing the partial‐PIC and partial‐SIC have been obtained, which shows a significant increase in both the maximum ablation depth (4.81 ± 0.87 mm vs. 3.30 ± 0.73 mm, p < 0.001) and the maximum ablation width (8.19 ± 0.85 mm vs. 6.47 ± 1.13 mm, p = 0.001).Conclusions(1) The electric field in the PIC is concentrated around the pair of electrodes, and the pattern of the field is a significant factor in the energy delivery along the direction of the depth. (2) The increase of the ablation depth can significantly expand the range of the tissue on the heart, where the PFA can apply, and can therefore readily form a layer of transmural damage on the heart wall at positions at which the wall is thicker.

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Outcomes of Focal Pulsed Field Ablation for Paroxysmal Supraventricular Tachycardia

Shen,

Du,

Dai

et al. 2024

Canadian Journal of Cardiology

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Safety and efficacy aspects of pulsed field ablation catheters as a function of electrode proximity to blood and energy delivery method

Cited by 9 publications

References 27 publications

Effect of Anisotropic Electrical Conductivity Induced by Fiber Orientation on Ablation Characteristics of Pulsed Field Ablation in Atrial Fibrillation Treatment: A Computational Study

Effect of Anisotropic Electrical Conductivity Induced by Fiber Orientation on Ablation Characteristics of Pulsed Field Ablation in Atrial Fibrillation Treatment: A Computational Study

A novel polarity configuration for enhancing ablation depth of pulsed field ablation: Design, modeling, and in vivo validation

Outcomes of Focal Pulsed Field Ablation for Paroxysmal Supraventricular Tachycardia

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