Pulsed-Field Ablation Using a Novel Ablation-Mapping Integrated System for Pulmonary Vein Isolation—A Preliminary Animal Study

Figures

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  Figure 1. PFA system. (A) The biphasic pulse generator was made by Hangzhou Ruidi Biotechnology and weighs 10 kg. (B) The mapping/ablation catheter was a 6-French multielectrode flexible circular catheter used for alternating current, bipolar PFA deliveries; the circular catheter includes three models (15, 20, and 25 mm). (C) A complete pulse includes positive and negative pulses with the same pulse amplitude and pulse width. The interval between positive and negative pulses is called the interphase. The pulse can be released at a fixed frequency or at each ventricular refractory period.

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  Figure 2. Pulmonary vein computed tomography angiography (CTA) and DSA images with PFA are shown. (A,B) CTA imaging for the CIPV anatomical measurements. (C,D) DSA is used for catheter positioning, CIPV and SVC ablations were performed during PFA.

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  Figure 3. Acute isolation of the SVC and CIPV. PFA is recorded from bipolar electrograms from the 10-electrode array; the PFA catheter is placed in the ostial of the SVC and CIPV. Electrogram signal reduction in the SVC and CIPV with PFA across the CIPV and SVC ostial treatment targets, only far-field signals remained. Complete electrical isolation of all structures was confirmed by the entrance block. White color for ECGI, avF, V1 leads; yellow color for coronary vein sinus electrode potential; green color for PFA catheter electrode potential.

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  Figure 4. Electrophysiologic evaluation of the CIPV treatment with PFA. Electrograms for the CIPV were reduced, and after trains were delivered, only far-field signals remained. (A,B) Electrograms before and after PFA; complete electrical isolation was confirmed by the entrance block. (C) A chronic map demonstrating isolated CIPV. (D) A potential reduction was observed 4 weeks after PFA, showing a level of isolation in the CIPV. ECG:Electrocardiogram; CS: coronary vein sinus; CIPV: common inferior pulmonary vein.

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  Figure 5. Electrophysiologic evaluation of the SVC treatment with PFA is shown. Electrograms for the SVC were reduced after the trains were delivered. (A,B) Electrograms before and after PFA; complete electrical isolation was confirmed by the entrance block. (C) A chronic map demonstrating isolated SVC. (D) Electrograms 4 weeks after PFA. ECG:electrocardiogram; CS: coronary vein sinus; SVC: superior vena cava.

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  Figure 6. Pathology. (A) Outer esophagus. (B) The outer phrenic nerve. (C–E) Internal aspect of the transmural lesions in the RSPV, CIPV, and SVC. Asterisks indicate the ablation area.

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  Figure 7. Hematoxylin and Eosin (E&A) staining. (A–C) Represent the phrenic nerve. (D–F) Represent the esophagus. Note that the cell boundaries are clear and neatly arranged without any damage.

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  Figure 8. Masson’s trichrome stain. (A) Normal PVs tissue. (B) Transmural damage to the RSPV tissue caused by PFA without stenosis. (C,D) The arrows point to transmural cardiomyocyte loss and an area with a relatively unaffected myocardium. (E) White: vascular structure; black: nerve tissue. (F) Transmural damage to the SVC caused by PFA. (G,H) The arrows point to transmural cardiomyocyte loss and an area with a relatively unaffected myocardium. Abbreviations: Epi, epicardial; Endo, endocardial.

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  Figure 9. Masson’s trichrome stain. (A) In a longitudinal section along the RSPV lesions, a transmural lesion is seen in the RSPV. (B) Section demonstrating non-transmural lesions in the SVC.