Fundamentals of System Design for Cardiac Pulsed Field Ablation: Optimization of Safety, Efficacy, and Usability

Figures

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  FIGURE 1. Graphical depiction of optimized cardiac PFA performance and the iterative optimization of cardiac PFA system design to achieve a safe, effective, and usable system. [Colour figure can be viewed at wileyonlinelibrary.com]

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  FIGURE 2. Electromagnetic model of a simple bipolar focal PFA catheter, illustrating the changing electric field extent and geometry with changing voltage and electrode spacing. Example reversible electroporation (RE) and irreversible electroporation (IRE) thresholds are given for reference, though these thresholds depend on waveform and dosing. Modeling done with ANSYS software with homogeneous tissue conductivity of 0.66 S/m. [Colour figure can be viewed at wileyonlinelibrary.com]

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  FIGURE 3. Electromagnetic model of a simple bipolar focal PFA catheter, illustrating the changing electric field extent and geometry with changing ring electrode surface area (modeling done with ANSYS software with homogeneous tissue conductivity of 0.66 S/m). [Colour figure can be viewed at wileyonlinelibrary.com]

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  FIGURE 4. Graphical illustration of some basic characteristics of cardiac PFA waveforms, though there can be many variations. [Colour figure can be viewed at wileyonlinelibrary.com]

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  FIGURE 5. Graphical depiction of an example undesirable PFA feedback loop between trains of pulses of a muti‐train waveform, and waveform design factors that can be changed to improve the situation. [Colour figure can be viewed at wileyonlinelibrary.com]

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  FIGURE 6. Iterative human PFA dosing improvements for three different cardiac PFA systems for more durable PVI. (A) The Farapulse system with Farawave catheter [71]. (B) The Affera system with Sphere 9 catheter [73]. (C) The Centauri system with various focal ablation catheters [72]. Images reproduced by permission of the publisher. [Colour figure can be viewed at wileyonlinelibrary.com]