Discussion:
As new ablation modalities are introduced, it is important to develop tools that enable safe and effective treatment. For RF and Cryo, there have been decades of development to optimize the safety and efficacy of catheters, algorithms, and workflows. Innovations such as contact force sensing and real-time ablation indices have helped move thermal ablation workflows from empirical to reproducible11. PEF ablation for arrythmia treatment is still early in its development, as are the tools that will optimize its safe and effective delivery. Most current PEF platforms rely on fluoro or ICE to guide ablation as EAM integration is limited. Overtreatment is commonplace, and tools confirming tissue contact are lacking.
This study sought to evaluate the utility of CTC for PEF ablation using a unique investigational LAF catheter, LI system, and PEF system. Ventricular lesions and atrial lesion sets were successfully created in ten swine with CTC assessed using LI. Treatment size, conduction block, and electrical isolation of target structures were examined acutely (N=8) and chronically (N=2) using EAM, pacing maneuvers, and tissue histology. No adverse events or collateral damage were observed. Analysis of LI, tissue characteristics, and EAM demonstrated that with a unique LAF catheter 1) CTC is critical for consistent and effective PEF treatment, 2) above a minimum contact threshold, increasing CTC does not increase treatment size, and 3) LI can be an effective tool for assessing CTC during PEF ablation, but its application will differ from that of focal RF.