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Modified Unipolar Return Pulsed Field Ablation in Ventricular Myocardium.

Maria Terricabras1, Peter Lombergar2, Terenz Escartin1

  • 1Physical Sciences Platform, Sunnybrook Research Institute, University of Toronto, ON, Canada (M.T., T.E., P.K., J.B., G.W.).

Circulation. Arrhythmia and Electrophysiology
|October 1, 2025
PubMed
Summary

A novel pulsed field ablation (PFA) system with a modified unipolar return effectively created deep, consistent lesions in swine hearts. This PFA technology shows promise for treating both healthy and infarcted ventricular tissue.

Keywords:
atrial fibrillationcatheter ablationheart ventriclespulmonary veinstachycardia, ventricular

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Area of Science:

  • Cardiovascular Research
  • Medical Devices
  • Electrophysiology

Background:

  • Pulsed field ablation (PFA) parameters are being optimized to enhance lesion depth.
  • This study investigates a modified unipolar return PFA system for creating deep lesions in ventricular myocardium.

Purpose of the Study:

  • To evaluate a modified unipolar return PFA system for its ability to generate deep lesions.
  • To compare the efficacy of the modified system against a conventional unipolar return system.

Main Methods:

  • Numerical modeling was employed to compare system configurations.
  • Ablation procedures were conducted in 14 swine (healthy and infarcted models).
  • Lesion creation utilized a focal catheter with an inferior vena cava return electrode, employing biphasic, microsecond pulses.

Main Results:

  • Numerical modeling indicated the modified system produced deeper, less variable lesions than the skin patch.
  • In healthy swine, lesion depths up to 11.6 mm were achieved with 16 pulse trains.
  • In infarcted swine, lesions consistently penetrated fibrotic scar tissue, with 57% showing epicardial involvement.

Conclusions:

  • The modified unipolar return PFA system effectively creates large, transmural lesions in both healthy and infarcted swine ventricles.
  • This system demonstrates potential for improved lesion depth, width, and consistency compared to conventional unipolar PFA.