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. 2023 Aug 2;25(9):euad257.
doi: 10.1093/europace/euad257.

Determinants of acute irreversible electroporation lesion characteristics after pulsed field ablation: the role of voltage, contact, and adipose interference

Alessio Gasperetti  1 , Fabrizio Assis  1 , Hemantkumar Tripathi  1 , Masahito Suzuki  1 , Akhilesh Gonuguntla  1 , Rushil Shah  1 , James Sampognaro  1 , Marco Schiavone  2   3 , Parag Karmarkar  4 , Harikrishna Tandri  1
Affiliations

Determinants of acute irreversible electroporation lesion characteristics after pulsed field ablation: the role of voltage, contact, and adipose interference

Alessio Gasperetti et al. Europace. .

Abstract

Aims: Pulsed field ablation (PFA) is a non-thermal ablative approach in which cardiomyocyte death is obtained through irreversible electroporation (IRE). Data correlating the biophysical characteristics of IRE and lesion characteristics are limited. The aim of this study was to assess the effect of different procedural parameters [voltage, number of cycles (NoCs), and contact] on lesion characteristics in a vegetal and animal model for IRE.

Methods and results: Two hundred and four Russet potatoes were used. Pulsed field ablation 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 1 to 5×) protocols were used. The impact of 0.5 and 1 mm catheter-to-specimen distances was tested. A swine animal model was then used to validate the results observed in the vegetable model. The association between voltage, the NoCs, distance, and lesion depth was assessed through linear regression. 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 NoCs and the 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 (1000 V 2×: 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 the NoCs, with a quasi-linear relationship. The lack of catheter contact was associated with a dampening in lesion depth.

Keywords: Contact; Irreversible electroporation; Lesion characteristics; Pulse field ablation; Vegetal models; Voltage.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Experimental study workflow. A total of 204 potatoes and 10 piglets have been used in the study, grouped as represented. Each box represents a group of specimens. The presence of a piglet image over a box indicates the validation of those findings in an animal model. The number reported in the top right corner as a superscript represents the number of specimens in the group. The larger, rounded rectangles show for what analysis specimen groups were used. Grouping (assessments as per the Methods section)—top section, first rectangle: voltage assessment; top section, second rectangle: NoC assessment; top section, third rectangle: interaction between voltage and the NoCs; bottom section, first rectangle: adipose interference assessment; bottom section, second rectangle: contact assessment; NoCs, number of cycles.
Figure 2
Figure 2
Lesion surface area observed at different voltage protocols.
Figure 3
Figure 3
Relationship between voltage increases and maximal lesion depth (A) and between the NoCs and maximal lesion depth (B). NoCs, number of cycles.
Figure 4
Figure 4
Modification of lesion depth (in mm) at the variation of voltage and the NoCs. NoCs, number of cycles; V, voltage.
Figure 5
Figure 5
Significant lesion dampening observed in the presence of butter (mimicking intramyocardial fat characteristics).
Figure 6
Figure 6
Lesion obtained at 0.5 mm (left panel and lower panel) and at 1 mm (right panel) catheter-specimen distance.
See this image and copyright information in PMC

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