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.