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Parametric study of pulsed field ablation with biphasic waveforms in an in vivo heart model: the role of frequency

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dc.contributor.author Garcia-Sanchez, Tomas
dc.contributor.author Amorós Figueras, Gerard
dc.contributor.author Jorge, Esther
dc.contributor.author Campos, María C.
dc.contributor.author Maor, Elad
dc.contributor.author Guerra, Jose M.
dc.contributor.author Ivorra Cano, Antoni, 1974-
dc.date.accessioned 2022-10-13T06:15:47Z
dc.date.available 2022-10-13T06:15:47Z
dc.date.issued 2022
dc.identifier.citation García-Sánchez T, Amorós-Figueras G, Jorge E, Campos MC, Maor E, Guerra JM, Ivorra A. Parametric study of pulsed field ablation with biphasic waveforms in an in vivo heart model: the role of frequency. Circ Arrhythm Electrophysiol. 2022. 43 p. DOI: 10.1161/CIRCEP.122.010992
dc.identifier.issn 1941-3149
dc.identifier.uri http://hdl.handle.net/10230/54363
dc.description Data de publicació electrónica: 30-09-2022
dc.description.abstract BACKGROUND: Pulsed field ablation (PFA) is a novel non-thermal cardiac ablation technology based on irreversible electroporation. Unfortunately, the characteristics of the electric field waveforms used in clinical and experimental PFA are not typically reported. This study examines the effect of the frequency of biphasic waveforms and compares biphasic to monophasic waveforms. METHODS: A total of 29 Sprague-Dawley rats were treated with PFA using an epicardial monopolar electrode. Biphasic waveforms with three different frequencies, 90, 260 and 450 kHz (10 bursts of 100 µs duration at 500 V or 800 V) and monophasic waveforms (10 pulses of 100 µs duration at 500 V) were studied. Collateral neuromuscular stimulation and temperature increase in the point of application were directly measured. Lesion formation was assessed 3 weeks after treatment by histopathologic analysis. Computer simulations were used to estimate the electric field lethal threshold for each condition. A previous in vitro study was performed to draw a complete characterization of the studied dependencies. RESULTS: Morphometric analysis demonstrated a significant association between chronic lesion size and waveform characteristics. For the same voltage level, monophasic waveforms yielded the largest lesions compared to any of the biphasic protocols (p<0.05). Increasing PFA frequency was associated with reduced neuromuscular stimulation but also with reduced ablation efficacy. Maximum absolute temperature increase recorded along a complete treatment was 3 °C. Vascular structures inside the lesions were preserved for all conditions. Computer simulation-based analysis showed that waveform frequency had a graded effect on the lethal electric field threshold, with threshold of 600 V/cm for monophasic waveforms vs. 2000 V/cm for biphasic waveforms with a frequency of 450 kHz. CONCLUSIONS: Frequency is a major determinant of efficacy in biphasic PFA. Our results highlight the critical need of disclosing waveform characteristics when reporting the results of different PFA systems.
dc.description.sponsorship This work was partially supported by project (PID2019-110120RBI00/AEI/ 10.13039/501100011033) from the Ministry of Science, Innovation and Universities and the State Research Agency of the Spanish government. This project has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie SkłodowskaCurie grant agreement No 892393 (TACAIRE). Antoni Ivorra gratefully acknowledges financial support by ICREA under the ICREA Academia program.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher American Hearth Association
dc.relation.ispartof Circulation: Arrhythmia and Electrophysiology. 2022. 43 p.
dc.rights © American Hearth Association http://dx.doi.org/10.1161/CIRCEP.122.010992
dc.title Parametric study of pulsed field ablation with biphasic waveforms in an in vivo heart model: the role of frequency
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1161/CIRCEP.122.010992
dc.relation.projectID info:eu-repo/grantAgreement/ES/2PE/PID2019-110120RBI00
dc.rights.accessRights info:eu-repo/semantics/embargoedAccess
dc.type.version info:eu-repo/semantics/acceptedVersion
dc.embargo.liftdate 2023-03-30
dc.date.embargoEnd info:eu-repo/date/embargoEnd/2023-03-30


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