Speaker
Description
Pulsed field ablation (PFA) is an ablation technology for treatment of cardiac arrhythmias, which relies on electroporation. Although PFA has a nonthermal mechanism, some heating is expected due to the high power of the pulses. The presence of metallic cardiac implants may alter the electric field around the ablation catheter which may lead to increased heating. The aim was to investigate the PFA interaction with metallic devices: atrial appendage occlusion device, mechanical valve, stent, and ICD lead. A FEM model was developed in COMSOL including a tissue block, a bipolar or monopolar catheter, and different device geometries. Distance between catheter and device was varied from 1–20 mm. A 200 ms duration waveform: 2000 V, and 0.02 duty factor for monopolar delivery; 1800 V with a duty factor of 0.01 for bipolar delivery was used. The mean volume of ablation with Electric field >550 V/cm was 1.8 cm³ for monopolar and 1.6 cm3 for bipolar. At close distances to the implant the average relative change in ablation volume was -0.63 %, and -7.7 % for monopolar and bipolar delivery, respectively. Maximum tissue temperatures exceeded 100 °C when the catheter was positioned within 2 mm of the implant surface; at larger separations the temperature increase was substantially lower. At distances over 5 mm the thermal effect of the implants was negligible. Metallic implants increased the total current, with a peak increase of 30%, depending on implant geometry and catheter orientation.
Bibliography
[1] Chun. K. -R. J. et al., “State of the art pulsed field ablation for cardiac arrhythmias: ongoing evolution and future perspective”, EP Europace, vol.26, euae. 134, 2024
[2] D. Campos-Villarreal et al., “Visible Arcing Observed with Pulsed Field Ablation Applications Delivered Near a Left Atrial Appendage Occlusion Device”, Heart Rhythm, 2025
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[4] Sauer, W. H., Campos-Villarreal, D., & Steiger, N. A. (2025). Irrigation of Pulsed Field Ablation Electrodes Mitigates Joule Heating and the Heat Stacking Phenomena. JACC: Clinical Electrophysiology, 11(8), 1866–1868. https://doi.org/10.1016/j.jacep.2025.04.018
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