Is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed-field ablation?
Background: Pulsed-field ablation (PFA) is a novel cardiac ablation technology based on irreversible electroporation (IRE). PFA computational models rely on identification of a lethal electric field threshold to predict the IRE area. However, the predicted lesion anisotropy ratios (width over depth)...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-05-01
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| Series: | Heart Rhythm O2 |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501825000790 |
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| author | Argyrios Petras, PhD Gerard Amoros Figueras, PhD Zoraida Moreno Weidmann, MD Tomás García-Sánchez, PhD David Viladés Medel, MD, PhD Antoni Ivorra, PhD Jose M. Guerra, MD, PhD Luca Gerardo-Giorda, PhD |
| author_facet | Argyrios Petras, PhD Gerard Amoros Figueras, PhD Zoraida Moreno Weidmann, MD Tomás García-Sánchez, PhD David Viladés Medel, MD, PhD Antoni Ivorra, PhD Jose M. Guerra, MD, PhD Luca Gerardo-Giorda, PhD |
| author_sort | Argyrios Petras, PhD |
| collection | DOAJ |
| description | Background: Pulsed-field ablation (PFA) is a novel cardiac ablation technology based on irreversible electroporation (IRE). PFA computational models rely on identification of a lethal electric field threshold to predict the IRE area. However, the predicted lesion anisotropy ratios (width over depth) vary extensively among recent studies, and these discrepancies remain a subject of discussion. Objective: This work aims to evaluate the predicted lesion anisotropy ratios using a PFA computational model by applying it to an open-chest in vivo porcine model geometry. Methods: Six domestic swine underwent epicardial PFA applications using a previously described waveform protocol. Animals were killed at least 3 hours after the last ablation, and lesions were assessed using triphenyltetrazolium chloride (TTC) staining. Numeric simulations were performed on a segmented and meshed porcine thoracic computed tomography (CT) scan, mimicking the open-chest experimental setup. Results: The maximum width of all simulated lesions was observed at the epicardial surface. The anisotropy ratios (AR) of the experimental lesions were smaller than the simulated ones (AR experimental vs simulated, 1.0–1.7 vs 2–2.7; Q1–Q3 quartiles). Increasing the peak voltage resulted in larger lesions; however, the computational model clearly underestimated the increase in lesion depth compared with the experimental data. Conclusion: Our computational model shows that a single lethal electric field threshold is insufficient to accurately predict both lesion depth and width in cardiac PFA. Our study suggests that for the given PFA waveforms, a threshold between 270 and 500 V/cm provides satisfactory lesion depth estimations, and a higher threshold between 790 and 1000 V/cm better captures the lesion width. |
| format | Article |
| id | doaj-art-c33aa87002164c1198f58c0112e43f07 |
| institution | OA Journals |
| issn | 2666-5018 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj-art-c33aa87002164c1198f58c0112e43f072025-08-20T02:33:18ZengElsevierHeart Rhythm O22666-50182025-05-016567167710.1016/j.hroo.2025.02.014Is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed-field ablation?Argyrios Petras, PhD0Gerard Amoros Figueras, PhD1Zoraida Moreno Weidmann, MD2Tomás García-Sánchez, PhD3David Viladés Medel, MD, PhD4Antoni Ivorra, PhD5Jose M. Guerra, MD, PhD6Luca Gerardo-Giorda, PhD7RICAM–Johann Radon Institute for Computational and Applied Mathematics, Linz, AustriaDepartment of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBER CV, Barcelona, SpainDepartment of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBER CV, Barcelona, SpainDepartment of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, SpainDepartment of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBER CV, Barcelona, SpainDepartment of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, SpainDepartment of Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBER CV, Barcelona, SpainRICAM–Johann Radon Institute for Computational and Applied Mathematics, Linz, Austria; Institute for Mathematical Methods in Medicine and Data-Based Modelling, Johannes Kepler University, Linz, Austria; Address reprint requests and correspondence: Luca Gerardo-Giorda, PhD, Johannes Kepler University, Altenbergerstrasse 69, A-4040, Linz, Austria.Background: Pulsed-field ablation (PFA) is a novel cardiac ablation technology based on irreversible electroporation (IRE). PFA computational models rely on identification of a lethal electric field threshold to predict the IRE area. However, the predicted lesion anisotropy ratios (width over depth) vary extensively among recent studies, and these discrepancies remain a subject of discussion. Objective: This work aims to evaluate the predicted lesion anisotropy ratios using a PFA computational model by applying it to an open-chest in vivo porcine model geometry. Methods: Six domestic swine underwent epicardial PFA applications using a previously described waveform protocol. Animals were killed at least 3 hours after the last ablation, and lesions were assessed using triphenyltetrazolium chloride (TTC) staining. Numeric simulations were performed on a segmented and meshed porcine thoracic computed tomography (CT) scan, mimicking the open-chest experimental setup. Results: The maximum width of all simulated lesions was observed at the epicardial surface. The anisotropy ratios (AR) of the experimental lesions were smaller than the simulated ones (AR experimental vs simulated, 1.0–1.7 vs 2–2.7; Q1–Q3 quartiles). Increasing the peak voltage resulted in larger lesions; however, the computational model clearly underestimated the increase in lesion depth compared with the experimental data. Conclusion: Our computational model shows that a single lethal electric field threshold is insufficient to accurately predict both lesion depth and width in cardiac PFA. Our study suggests that for the given PFA waveforms, a threshold between 270 and 500 V/cm provides satisfactory lesion depth estimations, and a higher threshold between 790 and 1000 V/cm better captures the lesion width.http://www.sciencedirect.com/science/article/pii/S2666501825000790Cardiac ablationComputer simulationsPulsed field ablationElectric field thresholdMathematical modeling |
| spellingShingle | Argyrios Petras, PhD Gerard Amoros Figueras, PhD Zoraida Moreno Weidmann, MD Tomás García-Sánchez, PhD David Viladés Medel, MD, PhD Antoni Ivorra, PhD Jose M. Guerra, MD, PhD Luca Gerardo-Giorda, PhD Is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed-field ablation? Heart Rhythm O2 Cardiac ablation Computer simulations Pulsed field ablation Electric field threshold Mathematical modeling |
| title | Is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed-field ablation? |
| title_full | Is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed-field ablation? |
| title_fullStr | Is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed-field ablation? |
| title_full_unstemmed | Is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed-field ablation? |
| title_short | Is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed-field ablation? |
| title_sort | is a single lethal electric field threshold sufficient to characterize the lesion size in computational modeling of cardiac pulsed field ablation |
| topic | Cardiac ablation Computer simulations Pulsed field ablation Electric field threshold Mathematical modeling |
| url | http://www.sciencedirect.com/science/article/pii/S2666501825000790 |
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