Is Contact Needed for PEF Ablation?
Proximity of the field origin to targets and tissue homogeneity both
directly influence the impact of a critical PEF voltage
gradient7. Howard et al 9demonstrated ex vivo that maximum treatment size is achieved when
a catheter is in apposition to target tissue while displacement of the
electric field source from the tissue surface reduced lesion depth.
Contact force and LI are both well-established indicators of
CTC12,13. In this study, with ICE guidance, LI
consistently >Δ10Ω from baseline was found to be correlated
to stable CTC. PEF treatments delivered with >Δ10Ω LI
resulted in maximum treatment size and transmurality while treatments
delivered with ≤Δ10Ω LI (even with close proximity to tissue) resulted
in reduced lesion size or no discernable lesion acutely and chronically.
Intercaval lines containing 1-2 lesions with ≤Δ10Ω LI resulted in gaps.
Therefore, the data indicate CTC can optimize PEF treatment similar to
how thermal ablation feedback tools have improved workflows and patient
outcomes14–16.