Modified unipolar return pulsed field ablation in ventricular myocardium

Terricabras Casas, Maria (avtor), Lombergar, Peter (avtor), Escartin, Terenz (avtor), Kos, Bor (avtor), Krahn, Philippa R. (avtor), Barry, Jennifer (avtor), Wright, Graham (avtor), Jarm, Tomaž (avtor), Štublar, Jernej (avtor), Kranjc, Matej (avtor), Coulombe, Nicolas (avtor), Mattison, Lars M. (avtor), Sigg, Daniel C. (avtor), Miklavčič, Damijan (avtor), Verma, Atul (avtor)

BACKGROUND: Various pulsed field ablation (PFA) parameters have been proposed to improve lesion depth. This study evaluated a modified unipolar return PFA system to create deep lesions in healthy and infarcted ventricular myocardia. METHODS: Numerical modeling was used to compare a modified unipolar return PFA system configuration with a conventional unipolar return (skin patch). We then performed ablation in 14 swine (5 with chronic myocardial infarction and 9 healthy). PFA lesions were created in the left ventricle using a focal catheter (4-mm tip) with a return electrode positioned in the inferior vena cava (biphasic, microsecond pulses of 1300 and 1500 V, 1–16 trains). Electroanatomical mapping guided ablation and lesion localization on magnetic resonance imaging were performed 48 hours post-ablation in the infarcted group and at 1 day, 7 days, and 6 weeks post-ablation in the healthy group. RESULTS: Numerical modeling demonstrated that the modified unipolar return PFA system produced deeper lesions with reduced variability compared with the skin patch. In healthy pigs (n=35 lesions), depths of 6.8±1.8 mm and widths of 11.5±4.7 mm were achieved with 8 pulse trains. Depths of 8.2±2.8 mm and widths of 14.0±4.7 mm were achieved with 16 trains. The maximum lesion depths were 8.8 and 11.6 mm for 8 and 16 trains, respectively. In the infarcted cohort (n=22 lesions), all lesions applied to scar tissue penetrated through fibrotic regions, with epicardial involvement observed in 57% of lesions. CONCLUSIONS: The modified unipolar return PFA system effectively creates large lesions and can achieve transmurality in healthy and infarcted animals. Compared with conventional unipolar, it may offer greater lesion depth, width, and consistency. GRAPHIC ABSTRACT: A graphic abstract is available for this article.

• Jezik: Angleški jezik
• Ključne besede: atrial fibrillation, catheter ablation, heart ventricles, pulmonary veins, tachycardia ventricular
• Vrsta gradiva: Članek v reviji
• Tipologija: 1.01 - Izvirni znanstveni članek
• Organizacija: FE - Fakulteta za elektrotehniko
• Status publikacije: Objavljeno
• Različica publikacije: Objavljena publikacija
• Leto izida: 2025
• Št. strani: Str. 786-796
• Številčenje: Vol. 18, no. 10
• PID: 20.500.12556/RUL-175368
• UDK: 616.1:616.12
• ISSN pri članku: 1941-3084
• DOI: 10.1161/CIRCEP.125.014006
• COBISS.SI-ID: 254692099
• Datum objave v RUL: 24.10.2025

Gradivo je del revije

• Naslov: Circulation : arrhythmia and electrophysiology
• Skrajšan naslov: Circ. Arrhythm. electrophysiol.
• Založnik: Lippincott Williams & Wilkins
• ISSN: 1941-3084
• COBISS.SI-ID: 522451737

Licence

• Licenca: CC BY-NC-ND 4.0, Creative Commons Priznanje avtorstva-Nekomercialno-Brez predelav 4.0 Mednarodna
• Povezava: http://creativecommons.org/licenses/by-nc-nd/4.0/deed.sl
• Opis: Najbolj omejujoča licenca Creative Commons. Uporabniki lahko prenesejo in delijo delo v nekomercialne namene in ga ne smejo uporabiti za nobene druge namene.

Sekundarni jezik

• Jezik: Slovenski jezik
• Ključne besede: atrijska ablacija, katetrska ablacija, srčni ventrikli, pljučne vene, ventrikularna tahikardija

Projekti

• Financer: Medtronic