Key result
Left atrial appendage occluders minimally alter pulsed field ablation lesions, narrowing width by ~1 mm.
Why the study?
The effect of pulsed field ablation on tissues with left atrial appendage occluders had not been fully and effectively evaluated.
Does the presence of a left atrial appendage occluder (LAAO) alter the electric field distribution, ablation lesion geometry, and temperature rise during pulsed field ablation (PFA) in computational and ex vivo canine heart models?
Does the presence of a left atrial appendage occluder (LAAO) alter the electric field distribution, ablation lesion geometry, and temperature rise during pulsed field ablation (PFA) in computational and ex vivo canine heart models?
Answers are grounded in this paper and cite their sources.
Computational modeling and ex vivo canine heart experiments demonstrate that left atrial appendage occluders minimally impact pulsed field ablation lesion geometry and do not induce thermal injury, although specific catheter electrode configurations and close proximity to the metal scaffold can cause localized electric field distortion.
Background Pulsed field ablation (PFA) is a novel non-thermal technique, but its effect on tissues with left atrial appendage occluders (LAAOs) has not been fully and effectively evaluated. Objective: This comprehensive study systematically analyzes the influence of LAAOs on ablation zones and temperature rise via multiphysics coupled computational simulations and ex vivo tissue experiments. Methods A simplified target model was developed. Lesion extent was assessed using the 400 V/cm isoelectric contour, while temperature changes in the ablation zone were recorded simultaneously. Animal myocardial tissue was used for validation purposes. Results Electrode configuration significantly affected ablation outcomes. Configuration 2 exacerbated electric field distortion, causing incomplete lesion formation. The maximum temperature difference across configurations was 2.61°C, with a peak of 45.45°C. The spatial relationship between electrode and LAAO also quantitatively influenced the ablation zone. Ex vivo experiments showed negligible field distortion, uniform lesion width and depth, and progressive temperature rise with pulse parameters. Conclusion LAAO minimally impacts the target zone. Different electrode configurations adjust the ablation range without causing thermal injury. Ex vivo data confirmed the temperature rise effect. This study offers important clinical guidance for circular catheter PFA treatment in atrial fibrillation patients with an LAAO.
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Wang et al. (2026) studied Atrial fibrillation with left atrial appendage occlusion (computational and ex vivo canine model) (n=8). Pulsed field ablation (PFA) in the presence of a left atrial appendage occluder (LAAO) vs. Pulsed field ablation without left atrial appendage occluder / alternative electrode configurations was evaluated on Ablation zone dimensions (lesion width and depth) and peak temperature rise (MD -1.07 mm, p=0.001). Left atrial appendage occluders minimally affected pulsed field ablation lesions, with peak simulated temperatures of 45.45°C and only one ex vivo subgroup showing reduced lesion width (p=0.001).
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