The importance of electrode-tissue proximity in creating pulsed field ablation lesions: insights from a sub-acute preclinical model.

IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Nishaki K Mehta, Daniel Pinkhas, Lars M Mattison, Daniel C Sigg, Nicole Kirchhof, Al Patequi, Peter Khalil, David E Haines
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引用次数: 0

Abstract

Background: We sought to evaluate the anatomic and functional lesion development over time at different atrial sites immediately following delivery of pulsed field ablation (PFA).

Methods: Using a porcine model, PFA ablations were performed in the superior vena cava (SVC), right atrial lateral wall (RA), left atrial appendage (LAA), and right superior pulmonary vein (RSPV) using four different PFA profiles. Mapping was done sequentially in 5-20-min increments up to 280-min post lesion delivery for low voltage area (LVA) assessment and conduction velocity. Lesion characteristics were noted with voltage mapping immediately post ablation and at the serial time points.

Results: In 9 animals, 33 sites were ablated. None of the four different profiles across all sites showed any statistical difference on acute lesion formation or persistence. Higher tissue contact was observed in the SVC and RSPV and lower tissue contact was observed in the LAA and RA locations. Higher contact areas were noted to have higher density electroanatomic low voltage area (LVA) (12/14 vs 5/18, p = 0.01) and larger lesions on gross pathology (2 /14 vs 6/16, p = 0.01) compared to lower contact areas. Lesion regression occurred in 16/33 sites. Sustained lesions were significantly more prevalent in higher versus lower contact sites (65% vs 38%, p = 0.037).

Conclusion: The development of significant and durable lesions for PFA in a porcine model appears to be dependent on tissue proximity and contact.

Abstract Image

脉冲场消融病灶形成过程中电极-组织接近度的重要性:亚急性临床前模型的启示。
背景:我们试图评估脉冲场消融(PFA)术后不同心房部位的解剖和功能病变随时间的发展情况:方法:使用猪模型,使用四种不同的 PFA 配置文件在上腔静脉 (SVC)、右心房侧壁 (RA)、左心房附壁 (LAA) 和右上肺静脉 (RSPV) 进行 PFA 消融。在病变发生后的 280 分钟内,以 5-20 分钟为增量依次进行绘图,以评估低电压区(LVA)和传导速度。结果:9 只动物的 33 个部位被消融:结果:9 只动物的 33 个部位被消融。在所有部位的四种不同类型中,没有一种类型在急性病变形成或持续方面显示出任何统计学差异。在 SVC 和 RSPV 观察到较高的组织接触,而在 LAA 和 RA 位置观察到较低的组织接触。与接触较少的区域相比,接触较多的区域具有更高密度的电解剖低电压区(LVA)(12/14 vs 5/18,p = 0.01)和更大的病变(2/14 vs 6/16,p = 0.01)。有 16/33 个部位出现了病变消退。高接触区与低接触区相比,持续性病变的发生率明显更高(65% vs 38%,p = 0.037):结论:在猪模型中,PFA 明显而持久的病变似乎取决于组织的接近性和接触性。
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来源期刊
CiteScore
4.30
自引率
11.10%
发文量
320
审稿时长
4-8 weeks
期刊介绍: The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.
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