Epicardial Pulsed Field Ablation of Ganglionated Plexi: Computational and Pre-Clinical Evaluation of a Bipolar Sub-Xiphoid Catheter for the Treatment of Atrial Fibrillation

Figures

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  Figure 1. Location of key atrial ganglionated plexi (GPs) in humans. Oblique sinus (OS), right superior (RS), transverse sinus (TS), left superior (LS), and ligament of Marshall (LM).

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  Figure 2. Illustration of the bipolar subxiphoid device (blue) deployed in the transverse sinus using a steerable access sheath to assist with navigation within the pericardial space, after obtaining anterior subxiphoid access.

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  Figure 3. Geometry of the three-dimensional models, which includes different tissue layers below the devices (saline, fat, myocardial tissue, and blood). The layer geometry is the same for the three devices. On the right, the three devices modeled are as follows: monopolar open chest Glove, monopolar open-chest Finger, and bipolar subxiphoid device. The electrodes of the bipolar device are numbered for the ablation pairings.

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  Figure 4. Anterior (A) and posterior (B) GPs in the porcine model. (Adapted from Aksu et al., J Cardiovasc Electrophysiol. 2021 [26]).

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  Figure 5. Geometry of the electric field within 400 V/cm and 1000 V/cm isolines for the monopolar open-chest Glove device. The 1000 V/cm volume is shown separately, as the merged profiles obscure the true shape of this. Length is obtained in the X direction, width in Y direction, and depth in Z direction.

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  Figure 6. Geometry of the electric field within 400 V/cm and 1000 V/cm isolines for the monopolar open-chest Finger device.

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  Figure 7. Geometry of the electric field within 400 V/cm and 1000 V/cm isolines for the bipolar B1 and B2 configurations of the subxiphoid device. The 1000 V/cm volume is shown separately as the merged profiles obscure the true shape of this.

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  Figure 8. Current streamlines for the monopolar Glove device (A) and Finger device (B).

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  Figure 9. Current streamlines for the bipolar device applying the energy in BP1 (A) and BP2 (B) configurations.

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  Figure 10. Ganglia showing neuronal cell bodies with loss of S-100 staining (LS). Scale bar = 100 µm.

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  Figure 11. Ganglia showing neuronal cell bodies with loss of S-100 staining (LS) as well as some with normal staining (NS) retained. Scale bar = 100 µm.

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  Figure 12. H–E stain showing myocardium damage at ablation site, showing contraction band necrosis, epicardial hemorrhage (EH), inflammation (EI), and collagenolysis (CL). Scale bar = 100 µm.