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PV Isolation Using a Spherical Array Pulsed Field Ablation Catheter
Quick Takes
- In a preclinical study, a 122 gold-plated multielectrode array catheter is capable of delivering both microsecond pulsed field (PF) and radiofrequency (RF) ablation with high efficacy and safety.
- On necropsy study, linear lesions created with RF, PF + RF, and PF had no significant differences in depths and transmurality.
Study Questions:
What are the necropsy and histopathology findings of sacrificed dogs following microsecond pulsed field (PF) and radiofrequency (RF) ablation using a novel multielectrode array?
Methods:
Under general anesthesia, a 122 gold-plated multielectrode array was introduced in the left atrium. Twenty-nine dogs underwent isolation of two pulmonary veins (PVs), linear and focal left atrial ablation with both RF (n = 12) and PF (n = 17). PF was also delivered within the superior vena cava and atop the esophagus in three swine. Animals were sacrificed acutely (immediate for RF [6/12] and 3 days for PF [6/17]) and the remaining (n = 17) at 14-30 days.
Results:
All PVs were acutely and durably isolated. Lesions were transmural for 97-100% of sections in the acute and chronic cohorts. Linear and focal lesions demonstrated transmurality rates of 83-100% in the acute cohort. In the chronic cohorts, linear lesions created with RF, PF + RF, and PF had no significant differences in depths, and transmurality was at 83.3%, 100%, and 80%, respectively. PF but not RF elicited bradycardia from ganglionated plexi stimulation. There were no instances of phrenic palsy, venous stenosis, esophageal damage, or thromboembolism.
Conclusions:
The authors conclude that circumferential, linear, and focal mapping and ablation can be achieved with this novel catheter using both PF and RF with excellent efficacy and safety.
Perspective:
PF ablation has been reported to be a safe and efficient method of tissue destruction with therapeutic effect. Prior reports described experience with PF catheters that did not have electroanatomic mapping capability. The current report concerns a novel design of a multielectrode spherical array catheter capable of mapping and ablating with either temperature-controlled RF or microsecond PF. The design is likely to further increase the efficiency of ablation procedures, and it appears to be safe and effective in this preclinical study.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Vascular Medicine
Keywords: Arrhythmias, Cardiac, Bradycardia, Cardiac Surgical Procedures, Catheter Ablation, Heart Failure, Pulmonary Veins, Radiofrequency Ablation, Stenosis, Pulmonary Vein, Thromboembolism
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