Abstract 19095: Enhancing Lesion Depth and Pulmonary Vein Isolation in Pulsed Field Ablation: Investigating the Effect of Voltage and Repeated Therapy Application

Abstract

Introduction: PFA has emerged as a promising approach for achieving effective PVI in the treatment of AF. This study investigates the impact of repeated therapy application and voltage on lesion depth during PFA and resulting PVI outcomes. By investigating this relationship, we seek to enhance lesion depth and optimize PFA protocols, ultimately leading to improved PVI outcomes and better management of AF patients. Methods: The VOLT TM PFA system was used to create lesions in potato sections with 37°C saline (N=3). Multiple PFA therapy repetitions were performed (1х, 2х, 4х, 6х, or 8х) at various voltages (1200V, 1400V, 1600V, or 1800V), with catheter rotation to achieve circumferential vein coverage. A chronic (30-day) canine study was performed at 1800V with 2х (Group 1, N=6) or 8х (Group 2, N=6) repetitions to understand in vitro to in vivo translation in terms of PVI success. Results: Two-way ANOVA results indicated that the effect of both voltage and therapy repetition was significant (P≤0.001) on minimum and maximum potato lesion depths. With increase in both voltage and repetition independently, lesion depths generally increased and 1800V as well as 8х produced significantly deeper lesions compared to 1200V and 1х, respectively. Functional block was achieved acutely in all veins at 30 min post treatment. Chronic functional block results were 87.5% for Group 1 (5/6 LSPV, 4/6 RSPV, 6/6 LIPV, 6/6 RIPV) and 100% for Group 2 (6/6 LSPV, 6/6 RSPV, 6/6 LIPV, 5/5 RIPV), showing increased success with repeated PFA ablation. All Group 1 PVs without chronic block were shown to be misaligned with the target vein, while 8 applications in Group 2 overcame less ideal PV alignment. Conclusions: Results suggest that through optimized voltage and therapy repetition, PFA can significantly enhance lesion depth, leading to improved PVI in AF treatment. Chronic PVI rates were improved from Group 1 to 2 at 1800V with additional PFA applications, compensating for less ideal PV alignment in Group 1.