Thermal profiles of pulsed field ablation catheters.

BACKGROUND

Pulsed field ablation (PFA) induces cell death predominantly through irreversible electroporation (IRE), a non-thermal mechanism. However, Joule heating during PFA delivery may result in clinically relevant temperature rises.

OBJECTIVES

This study aimed to characterize the thermal profiles, peak surface temperatures, and ablation lesions produced by 6 proprietary PFA catheters using an ex vivo vegetal model.

METHODS

The thermal profile of 6 PFA catheters-Farawave, PulseSelect, Volt, Varipulse, Electropulse, and Sphere-9-was evaluated in Solanum Tuberosum at recommended energy settings. Thermal imaging was performed using a high-resolution infrared camera. Standard PFA applications were delivered in 5 independent runs for each catheter. Post-ablation, specimens were stained with 0.5% triphenyl tetrazolium chloride (TTC) to delineate IRE and reversible electroporation (RE).

RESULTS

All systems demonstrated reproducible and distinct thermal signatures. Mean peak temperature rises were as follows: Varipulse low irrigation flow (4 mL/minute), 15.1°C ± 1°C; Farawave basket, 13.6°C ± 0.6°C; Farawave flower, 9.7°C ±0.4°C; Varipulse high irrigation flow (30 mL/minute), 8.5°C±0.5°C; PulseSelect, 4.1°C ± 0.6°C; Electropulse, 2.7°C ±0.7°C; Sphere-9, 2.1°C ±1.2°C; and Volt, 1.3°C ± 0.2°C (Kruskal-Wallis, P < .0001). PFA catheters demonstrated either localized or distributed thermal hotspot patterns. Localized hotspot catheters confined heating within 1 mm of the electrode margin, whereas distributed hotspot catheters exhibited additional peripheral hotspots beyond 5 mm, as observed with the Farawave catheter. All catheters produced well-demarcated TTC-unstained IRE lesions surrounded by a rim of TTC-stained RE tissue.

CONCLUSION

PFA systems exhibit distinct thermal signatures and can be categorized as low (0°C-6°C), moderate (6°C-12°C), or high (12°C-18°C°C) heating profile catheters.