Catheter-Tissue Contact Optimizes Pulsed Electric Field Ablation with a
Large Area Focal Catheter
Abstract
Introduction: Pulsed electric field (PEF) ablation relies on
the intersection of a critical voltage gradient with tissue to cause
cell death. Field-based lesion formation with PEF technologies may still
depend on catheter-tissue contact (CTC). The purpose of this study was
to assess the impact of CTC on PEF lesion formation with an
investigational large area focal (LAF) catheter in a preclinical model.
Methods: PEF ablation via a 10-spline LAF catheter was used to
create discrete RV lesions and atrial lesion sets in 10 swine (8 acute,
2 chronic). Local impedance (LI) was used to assess CTC. Lesions were
assigned to 3 cohorts using LI above baseline: No Tissue Contact (NTC:
≤∆10Ω, close proximity to tissue), Low Tissue Contact (LTC: ∆11-29Ω),
and High Tissue Contact (HTC: ≥∆30Ω). Acute animals were infused with
triphenyl tetrazolium chloride (TTC) and sacrificed ≥2hrs
post-treatment. Chronic animals were remapped 30 days post-index
procedure and stained with infused TTC. Results: Mean (±SD) RV
treatment sizes between LTC (n=14) and HTC (n=17) lesions were not
significantly different (depth: 5.65±1.96mm vs 5.68±2.05mm, p=0.999;
width: 15.68±5.22mm vs 16.98±4.45mm, p=0.737) while mean treatment size
for NTC lesions (n=6) was significantly smaller (1.67±1.16mm depth,
5.97±4.48mm width, p<0.05). For atrial lesion sets, acute and
chronic conduction block were achieved with both LTC (N=7) and HTC
(N=6), and NTC resulted in gaps. Conclusions: PEF ablation with
a specialized LAF catheter in a swine model is dependent on CTC. LI as
an indicator of CTC may aid in the creation of consistent transmural
lesions in PEF ablation.