Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Experimental methods D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-149 - The Effect Of Pulsed Field Ablation On The Esophagus: A Preclinical Model Using A Novel Lattice Tip Catheter (ID 467)

 H. Yavin: Nothing relevant to disclose.


Background: Pulsed-field is a non-thermal energy that may be advantageous for AF ablation as it may prevent esophageal injury. The effect of pulsed-field ablation (PFA) on esophageal tissue has not been studied due to lack of a clinically relevant model.
Objective: To develop a preclinical model for evaluating the effect of PFA on the esophagus.
Methods: In step 1, a deflectable sheath was used to deviate the esophagus closer to the posterior right atrium (RA). High-dose radiofrequency ablation (RFA; Tm 72°C, 5 sec) was applied to the RA with the lattice catheter (Sphere9TM; Affera Inc.) to validate the model. In step 2, PFA (24A) was applied to the RA, and swine were survived for 7 days. In step 3, both RFA and PFA were applied to the esophageal lumen at alternating spatial sequence to evaluate their direct effect on the esophagus. Swine were survived for 24 hours, and then the esophagi were analyzed using histopathology.
Results: In step 1 (n=1), the deflectable sheath deviated the esophagus <10 mm from the posterior RA and high-dose RFA resulted in esophageal injury, validating the esophageal-deviation model. In step 2 (n=4), 23 ± 2 PFA applications per animal were applied to the RA 7.6 ± 4.3 mm from the esophagus, producing transmural atrial lines without esophageal injury. In step 3 (n=4), PFA (17 ± 2 applications) and RFA (13 ± 1 applications) were applied directly to the lumen of the esophagus. All RFA lesions resulted in esophageal injury while PFA had no effect on the esophageal tissue (Figure).
Conclusion: PFA using a novel lattice catheter appears to be selective to cardiac tissue, avoiding esophageal injury.