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Evaluation of Ablation Parameters to Predict Irreversible Lesion Size During Pulsed Field Ablation.
Nakagawa, Hiroshi; Farshchi-Heydari, Salman; Maffre, Jennifer; Sharma, Tushar; Govari, Assaf; Beeckler, Christopher T; Altmann, Andres; Ikeda, Atsushi; Sugawara, Masafumi; Jackman, Warren M; Hussein, Ayman A; Nakhla, Shady; Santangeli, Pasquale; Saliba, Walid I; Wazni, Oussama M.
Afiliación
  • Nakagawa H; Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., A.A.H., S.N., P.S., W.I.S., O.M.W.).
  • Farshchi-Heydari S; Biosense Webster, Inc, Irwindale, CA (S.F.-H., J.M., T.S., C.T.B.).
  • Maffre J; Biosense Webster, Inc, Irwindale, CA (S.F.-H., J.M., T.S., C.T.B.).
  • Sharma T; Biosense Webster, Inc, Irwindale, CA (S.F.-H., J.M., T.S., C.T.B.).
  • Govari A; Biosense Webster, Yokneam, Israel (A.G., A.A.).
  • Beeckler CT; Biosense Webster, Inc, Irwindale, CA (S.F.-H., J.M., T.S., C.T.B.).
  • Altmann A; Biosense Webster, Yokneam, Israel (A.G., A.A.).
  • Ikeda A; Department of Cardiology, Nihon University, Tokyo, Japan (A.I.).
  • Sugawara M; Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., A.A.H., S.N., P.S., W.I.S., O.M.W.).
  • Jackman WM; Heart Rhythm Institute, The University of Oklahoma (W.M.J.).
  • Hussein AA; Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., A.A.H., S.N., P.S., W.I.S., O.M.W.).
  • Nakhla S; Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., A.A.H., S.N., P.S., W.I.S., O.M.W.).
  • Santangeli P; Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., A.A.H., S.N., P.S., W.I.S., O.M.W.).
  • Saliba WI; Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., A.A.H., S.N., P.S., W.I.S., O.M.W.).
  • Wazni OM; Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.N., M.S., A.A.H., S.N., P.S., W.I.S., O.M.W.).
Circ Arrhythm Electrophysiol ; 17(8): e012814, 2024 Aug.
Article en En | MEDLINE | ID: mdl-39051118
ABSTRACT

BACKGROUND:

During pulsed field ablation (PFA), relationships between ablation parameters (contact force [CF], number of burst pulses, impedance decrease, and electrode temperature) and lesion size in beating hearts have not been well validated.

METHODS:

A 7.5F-catheter with a 3.5-mm ablation electrode and CF sensor (ThermoCool SmartTouch SF-Dual-Energy, Biosense Webster, Inc, Irwindale, CA) was connected to a PFA system (TRUPULSE2, Biosense Webster, Inc). In 11 closed-chest swine, biphasic PFA current was delivered between the ablation electrode and the skin patch at 219 sites in left ventricle and right ventricle using 12, 18, and 24 burst pulses with 4 different levels of CF (1) low (n=57; CF, 4-15g; median, 10g); (2) moderate (n=60; CF, 16-30g; median, 22.5g); (3) high (n=68; CF, 32-65g; median, 40g); and (4) no electrode contact (n=34), 2 mm away from the endocardium. Swine were euthanized 2 hours after ablation, and lesion size was measured using triphenyl tetrazolium chloride staining.

RESULTS:

All PFA lesions with electrode-myocardium contact were well demarcated with triphenyl tetrazolium chloride staining, demonstrating (1) pale central zone (contraction band necrosis with minimal coagulation necrosis), (2) dark brown zone (contraction band necrosis with hemorrhage), and (3) hyperstained red zone by triphenyl tetrazolium chloride (unaffected normal myocardium with preserved mitochondrial activity, consistent with reversible zone). Lesion depth increased significantly with increasing CF and the number of PFA burst pulses. An exponential/logarithmic formula combined with CF and the number of PFA burst pulses correlated lesion depth with high accuracy R=0.809, P<0.0001, ±1.0-mm accuracy in 128 of 163 (79%) lesions, and ±1.5-mm accuracy in 153 of 163 (94%) lesions. Impedance decrease and electrode temperature were poor predictors of lesion size. There were no detectable lesions resulting from ablation without electrode contact.

CONCLUSIONS:

Acute PFA ventricular lesions demonstrate irreversible and reversible lesion boundaries. Electrode-tissue contact is required for effective lesion formation. Lesion depth increases significantly with increasing CF and PFA burst pulses. A new exponential/logarithmic formula combined with CF and the number of PFA burst pulses correlates lesion depth with high accuracy.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ablación por Catéter Límite: Animals Idioma: En Revista: Circ Arrhythm Electrophysiol Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ablación por Catéter Límite: Animals Idioma: En Revista: Circ Arrhythm Electrophysiol Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos