Impact of contact force and pulsed field ablation parameters on myocardial lesion formation during pulsed field ablation: A systematic review of pre-clinical studies

Pulsed field ablation (PFA) is a novel and minimally thermal energy source that exploits the biophysics of irreversible electroporation (IRE) to cause cell death. Differently from radiofrequency ablation (RFA) where adequate catheter-tissue contact proved paramount in lesion formation, the additional role of contact force (CF) during PFA is under debate due to the inherent myocardial selectivity and the customizable nature of IRE. In fact, it is not clear whether the amount of contact exerted during PFA delivery is as pivotal in achieving optimal lesion size as during RFA. Moreover, the variety of PFA catheters and the myriads of IRE ablation settings available would further potentially limit the role of CF in this scenario. However, beyond CF, specific ablation parameters, such as the PFA dose, number of pulses, catheter tip orientation and specific PFA workflows, proved to act in synergy with CF in achieving wide and deep ablation lesions even during PFA delivery. Therefore, the aim of this systematic review is to provide a better understanding on which ablation parameters - CF included - can help to obtain effective lesion formation during PFA.