Heat delivery accompanying pulsed field ablation

Area of Science:

• Cardiovascular Ablation Technologies
• Electrophysiology
• Biomedical Engineering

Background:

• Pulsed Field Ablation (PFA) offers an alternative to thermal ablation for pulmonary vein isolation.
• PFA utilizes high-intensity electric fields to induce cell electroporation, distinct from thermal mechanisms.
• While PFA is generally considered non-thermal, esophageal temperature increases have been anecdotally reported.

Purpose of the Study:

• To investigate the theoretical basis for observed esophageal temperature increases during PFA.
• To model the potential thermal effects of PFA in a worst-case scenario.

Main Methods:

• Development of a mathematical model simulating PFA energy delivery.
• Inclusion of parameters representing electrical field propagation and tissue properties.
• Analysis of heat generation and transfer in the esophageal vicinity.

Main Results:

• The mathematical model demonstrates that PFA can theoretically induce a non-negligible rise in esophageal luminal temperature.
• Simulation results indicate that specific PFA parameters and proximity can exacerbate this thermal effect.
• The findings provide a theoretical framework for understanding unexpected esophageal heating during PFA procedures.

Conclusions:

• PFA, despite its non-thermal mechanism, carries a theoretical risk of esophageal thermal injury.
• Mathematical modeling is crucial for understanding and mitigating potential adverse thermal events in PFA.
• Further research and clinical monitoring are warranted to fully assess and manage PFA-related esophageal temperature changes.