Determinants of acute irreversible electroporation lesion characteristics after pulsed field ablation: the role of voltage, contact, and adipose interference
Alessio Gasperetti, Fabrizio Assis, Hemantkumar Tripathi, Masahito Suzuki, Akhilesh Gonuguntla, Rushil Shah, James Sampognaro, Marco Schiavone, Parag Karmarkar, Harikrishna Tandri- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Abstract
Background
Pulsed field ablation (PFA) is a non-thermal ablative approach in which cardiomyocyte death is obtained through irreversible electroporation (IRE). Data correlating biophysical characteristics of IRE and lesion characteristics are limited.
Objectives
To assess the effect of different procedural parameters (voltage, number of cycles (NoC), and contact) on lesion characteristics in a vegetal and animal model for IRE.
Methods
Two hundred four Russet potatoes were used. PFA lesions were delivered on 3-cm cored potato specimens using a multi-electrode circular catheter with its dedicated IRE generator. Different voltage (from 300 to 1200 V) and NoC (from 1x to 5x) protocols were used. Impact of 0.5 mm and 1 mm catheter-to-specimen distance was tested. A swine animal model was then used to validate results observed in the vegetable model. Association between V, NoC, distance and lesion depth were assessed through linear regression.
Results
An almost perfect linear association between lesion depth and voltage was observed (R2=0.95; p<0.001). A similarly linear relationship was observed between the NoC and lesion depth (R2=0.73; p<0.001). Compared with controls at full contact, a significant dampening on lesion depth was observed at 0.5 mm distance (1000V 2x: 2.11±0.12 vs 0.36±0.04, p<0.001; 2.63±0.10 vs 0.43±0.08, p<0.001). No lesions were observed at 1.0 mm distance.
Conclusion
In a vegetal and animal model for IRE assessment, PFA lesion characteristics were found to be strongly dependent on voltage settings and NoC, with a quasi-linear relationship. Lack of catheter contact was associated with dampening in lesion depth.