Is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed-field ablation?
Petras, A. (RICAM-Johann Radon Institute for Computational and Applied Mathematics)
Amorós Figueras, Gerard (Institut de Recerca Sant Pau)
Moreno Weidmann, Zoraida (Institut de Recerca Sant Pau)
García-Sánchez, Tomás (Universitat Pompeu Fabra)
Viladés Medel, David (Institut de Recerca Sant Pau)
Ivorra, A. (Universitat Pompeu Fabra)
Guerra Ramos, José María (Institut de Recerca Sant Pau)
Gerardo-Giorda, L. (Johannes Kepler University)
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2025
Resum:	Background: Pulsed-field ablation (PFA) is a novel cardiac ablation technology based on irreversible electroporation (IRE). PFA computational models rely on identification of a lethal electric field threshold to predict the IRE area. However, the predicted lesion anisotropy ratios (width over depth) vary extensively among recent studies, and these discrepancies remain a subject of discussion. Objective: This work aims to evaluate the predicted lesion anisotropy ratios using a PFA computational model by applying it to an open-chest in vivo porcine model geometry. Methods: Six domestic swine underwent epicardial PFA applications using a previously described waveform protocol. Animals were killed at least 3 hours after the last ablation, and lesions were assessed using triphenyltetrazolium chloride (TTC) staining. Numeric simulations were performed on a segmented and meshed porcine thoracic computed tomography (CT) scan, mimicking the open-chest experimental setup. Results: The maximum width of all simulated lesions was observed at the epicardial surface. The anisotropy ratios (AR) of the experimental lesions were smaller than the simulated ones (AR experimental vs simulated, 1. 0-1. 7 vs 2-2. 7; Q1-Q3 quartiles). Increasing the peak voltage resulted in larger lesions; however, the computational model clearly underestimated the increase in lesion depth compared with the experimental data. Conclusion: Our computational model shows that a single lethal electric field threshold is insufficient to accurately predict both lesion depth and width in cardiac PFA. Our study suggests that for the given PFA waveforms, a threshold between 270 and 500 V/cm provides satisfactory lesion depth estimations, and a higher threshold between 790 and 1000 V/cm better captures the lesion width.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cardiac ablation ; Computer simulations ; Electric field threshold ; Mathematical modeling ; Pulsed field ablation
Publicat a:	Heart Rhythm O2, Vol. 6 Núm. 5 (may 2025) , p. 671-677, ISSN 2666-5018

DOI: 10.1016/j.hroo.2025.02.014
PMID: 40496584

7 p, 1.4 MB

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