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Thermal side effects during pulsed field ablation: an analysis using computer modelling.

Marcela Mercado-Montoya1, Tatiana Gomez-Bustamante1, Steven R Mickelsen2

  • 1Bioengineering Department, IN SILICO STEM S.A.S, Calle 52 81-48, Medellín 050035, Colombia.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|February 17, 2025
PubMed
Summary
This summary is machine-generated.

Pulsed field ablation (PFA) can cause thermal effects, particularly at higher voltages. This study shows peak voltage significantly impacts energy deposition and potential tissue injury during PFA procedures.

Keywords:
In silico modellingAtrial fibrillationComputational analysisPulsed field energySimulationThermal ablation

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Area of Science:

  • Cardiology
  • Oncology
  • Biomedical Engineering

Background:

  • Pulsed field ablation (PFA) is considered non-thermal, but thermal effects have been observed in clinical applications.
  • The specific parameters influencing thermal energy generation during PFA remain incompletely understood.

Purpose of the Study:

  • To numerically assess the thermal effects of PFA on myocardial and esophageal tissues.
  • To investigate the influence of varying peak voltage conditions on thermal energy development during PFA.

Main Methods:

  • A 3D computer model of the left atrium was utilized to quantify thermal effects.
  • PFA was simulated using a bipolar configuration with specific electrical boundary conditions.
  • A monophasic waveform (100 μs pulse width, 1 s gap) was applied for 50 pulses at 1, 1.5, and 2 kV.

Main Results:

  • Minimal esophageal temperature rise was observed at 1 kV (214.5 J).
  • Temperatures reached 46.3°C and >62°C at 1.5 kV (570.3 J) and 2 kV (1.23 kJ) after a single pulse train, respectively.
  • Repeated PFA applications may lead to significant temperature increases, especially with good tissue contact.

Conclusions:

  • Thermal effects in PFA are dependent on total energy deposited, with peak voltage being a key determinant.
  • Current PFA systems may induce collateral thermal injury with repeated use.
  • Careful monitoring and adjustment of PFA parameters are crucial in clinical practice.