Computational Assessment of Electrical and Thermal Effects of Epicardial Pulsed Field Ablation Adjacent to Stented Arteries
Abstract
Background: Current ablation strategies for the treatment of cardiac arrhythmias remain suboptimal. Treating cardiac arrhythmias using epicardial pulsed field ablation (PFA) selectively targets ganglionated plexi (GPs) within epicardial fat, offering a promising alternative to thermal ablation. Previous computational studies lacked physiological realism, excluding catheter geometry, fluid flow and post-PFA thermal latency. This study aimed to develop a realistic 3D epicardial PFA model integrating a clinical catheter, clinical PFA parameters and a sequentially coupled electro-thermal-fluid dynamics model, including thermal latency, to assess electrical and thermal collateral effects near stented coronary arteries.
Methods: The model included epicardial fat, myocardium, blood, and the left circumflex artery containing a metallic stent positioned 0.25 mm beneath the catheter electrodes. Pulses of 1000, 2000, and 2500 V (60 pulses × 100 µs, 1 Hz) were simulated to analyze electric field distribution, PFA-induced lesion volume, temperature evolution, and Arrhenius-based thermal damage, including a 90 s post-pulse period to account for thermal latency. The PFA-threshold of 1000 V/cm was considered.
Results: The artery reduced PFA-induced lesion size mainly by occupying fat tissue volume, while the stent shielded the lumen without altering fat lesion volume. The presence of a stent produced localized electric field enhancement at the arterial wall, with up to 3.83% of the arterial…
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