Effect of Epicardial Pulsed Field Ablation Directly on Coronary Arteries.

Abstract

The unique tissue selectivity of pulsed field ablation (PFA) allows for minimizing collateral damage to the nerves/esophagus. However, the safety profile of epicardial PFA on coronary arteries (CAs) has not been well defined. This study sought to evaluate the effect of epicardial PFA directly on CAs in a swine model. In 4 swine, an 8-F linear quadripolar PFA catheter (FARAPULSE Inc) was introduced into the pericardial space via a subxiphoid puncture. After coronary angiography (Angio), QRS synchronized, biphasic, bipolar PFA was delivered directly on the left anterior descending artery, left circumflex artery, or normal myocardium (control) (2.0 kV× 4 applications per site). Angio was repeated immediately after ablation and repeated every 5minutes to quantify the degree of CA narrowing. After 4- or 8-week survival, repeat Angio was performed followed by gross and histologic lesion analyses. A total of 15 lesions were delivered (8 left anterior descending arteries, 3 left circumflexes, and 4 controls). Target site Angio revealed median of 47% (IQR: 38%-69%) acute luminal narrowing immediately after PFA, which gradually resolved over 30minutes. Epicardial PFA lesions extended into the myocardium with a median depth of 4.1mm (IQR: 3.6-5.6mm) passing across the CAs and adipose tissue. However, 87.5% of the CAs demonstrated minimal to mild CA stenosis associated with neointimal hyperplasia and tunica media fibrosis. In a swine model, epicardial PFA directly on CAs allowed the creation of myocardial lesions but led to aCA response characterized by acute moderate spasm and chronic mild stenosis via neointimal hyperplasia.