Redesigning Pulsed Field Ablation Catheter Form Factors for Lesion Precision, Durability, and Safety

Pulsed field ablation (PFA) is a cutting-edge treatment for arrhythmias that targets cardiac tissue with rapid, high-voltage electric current pulses, resulting in irreversible electroporation. Freed from the constraints of traditional radiofrequency (RF) ablation, the non-thermal mechanism and myocardial selectivity of PFA has improved procedural safety aspects and efficiency over RF ablation. However, catheter development thus far has focused on waveforms and voltage, such that critical aspects related to the physics of energy delivery at the tissue-blood interface were often overlooked. When delivering high-voltage pulsed electric fields, differences in electrical impedance, catheter geometry, and field strength impact the resulting precision and durability of lesions; principles that warrant a deeper understanding to inform and optimize future catheter designs. This article examines the engineering considerations behind the success of the first industrial iterations of PFA, with a comparison of catheter form factors for current systems that impact energy delivery, workflow, safety, and performance. We also address the initial assumptions and misconceptions related to PFA design and the development of current generation catheters as considerations for the future of ablation and mapping.