Effect of Contact Force on Pulsed Field Ablation Lesions in Porcine
Cardiac Tissue
Abstract
Background: Contact force has been used to titrate lesion
formation for radiofrequency ablation. Pulsed Field Ablation (PFA) is a
field-based ablation technology for which limited evidence on the impact
of contact force on lesion size is available. Methods: Porcine
hearts (n=6) were perfused using a modified Langendorff set-up. A
prototype focal PFA catheter attached to a force gauge was held
perpendicular to the epicardium and lowered until contact was made.
Contact force was recorded during each PFA delivery. Matured lesions
were cross-sectioned, stained, and the lesion dimensions were measured.
Numerical modeling of the catheter-tissue interface under different
contact forces was performed to aid in the interpretation of our results
and isolate effects of biomechanical tissue displacement.
Results: A total of 82 lesions were evaluated with contact
forces between 1.3 g and 48.6 g. Mean lesion depth was 4.8 ± 0.9 mm
(standard deviation), mean lesion width was 9.1 ± 1.3 mm and mean lesion
volume was 217.0. ± 96.6 mm 3. Linear regression
curves showed an increase of only 0.01 mm in depth (Depth = 0.01*Contact
Force + 4.37, R 2 = 0.06), 0.03 mm in width (Width =
0.03*Contact Force + 8.32, R 2 = 0.12) for each
additional gram of contact force, and 2.20 mm 3 in
volume (Volume = 2.20*Contact Force + 163, R 2 =
0.11). Numerical modeling found consistent trends with experimental mean
values and shows tissue displacement alone is likely not a significant
factor to formation of lesion depth. Conclusions: Increasing
contact force using a bipolar, biphasic focal PFA system has minor
effects on acute lesion dimensions in an isolated porcine heart model.