How intramyocardial fat can alter the electric field distribution during Pulsed Field Ablation (PFA): Qualitative findings from computer modeling

Even though the preliminary experimental data suggests that cardiac Pulsed Field Ablation (PFA) could be superior to radiofrequency ablation (RFA) in terms of being able to ablate the viable myocardium separated from the catheter by collagen and fat, as yet there is no formal physical-based analysis...

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Bibliographic Details
Published in:PloS one 2023-11, Vol.18 (11), p.e0287614-e0287614
Main Authors: Pérez, Juan J, González-Suárez, Ana
Format: Article
Language:English
Subjects:
Ablation
Ablation (Surgery)
Biology and Life Sciences
Cardiology
Catheters
Collagen
Computer models
Computer simulation
Computer-generated environments
Conductivity
Connective tissue
Electric contacts
Electric fields
Electric properties
Electrical conductivity
Electrical resistivity
Electrodes
Engineering and Technology
Fibrosis
High voltage
Lesions
Mathematical models
Medical instruments
Medicine and Health Sciences
Modelling
Myocardium
Physical Sciences
Qualitative analysis
Radio frequency
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Summary:Even though the preliminary experimental data suggests that cardiac Pulsed Field Ablation (PFA) could be superior to radiofrequency ablation (RFA) in terms of being able to ablate the viable myocardium separated from the catheter by collagen and fat, as yet there is no formal physical-based analysis that describes the process by which fat can affect the electric field distribution. Our objective was thus to determine the electrical impact of intramyocardial fat during PFA by means of computer modeling. Computer models were built considering a PFA 3.5-mm blunt-tip catheter in contact with a 7-mm ventricular wall (with and without a scar) and a 2-mm epicardial fat layer. High voltage was set to obtain delivered currents of 19, 22 and 25 A. An electric field value of 1000 V/cm was considered as the lethal threshold. We found that the presence of fibrotic tissue in the scar seems to have a similar impact on the electric field distribution and lesion size to that of healthy myocardium only. However, intramyocardial fat considerably alters the electrical field distribution and the resulting lesion shape. The electric field tends to peak in zones with fat, even away from the ablation electrode, so that ‘cold points’ (i.e. low electric fields) appear around the fat at the current entry and exit points, while ‘hot points’ (high electric fields) occur in the lateral areas of the fat zones. The results show that intramyocardial fat can alter the electric field distribution and lesion size during PFA due to its much lower electrical conductivity than that of myocardium and fibrotic tissue.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0287614