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2024 Symposium
Is Force Sensing Useful and Necessary for Pulsed Field Ablation?
Dr. David Haines
Dr. David Haines (read in memoriam) passed away suddenly on February 10, 2024. At the 2024 AF Symposium he participated in a discussion about Force Sensing Usefulness for Pulsed Field Ablation. Here is a report on his last AF Symposium talk.
Most RF Operators Use Contact Force Sensing
Dr. Haines, Heart Rhythm Center, Corewell Health Beaumont, MI, acknowledged the obvious that most operators using Radio Frequency (RF) current (heat) also use contact force sensing. RF kills tissue by increasing current density which causes resistive heating and forms lesions. Whereas Pulsed Field Ablation (PFA) is a voltage field ablation technology. The voltage field distribution will determine the PFA lesion size.
Voltage Distribution Key to PFA Ablation
With RF, as you increase the contact force, there is more current distribution into the tissue which increases lesion size. But with PFA, increasing the contact force doesn’t really alter the field distribution deep into the tissue, though it may somewhat increase the footprint of the catheter.
Dr. Haines cited his own study where PFA lesion depth was flat and didn’t really change much over a range of different contact forces. PFA is a different system than RF where voltage field is what determines lesion depth.
Dr. Haines agreed that, if the Pulsed Field Catheter (PFA) is off of the targeted tissue by a couple of mms, the PFA energy won’t penetrate into the tissue. But he pointed out the most operators are not likely to miss their targets at all, let alone by single mm.
Is Contact Force Sensing for PFA Necessary?
Dr. Haines asked if contact force sensing is worth the added expense and complexity. “We don’t need it.”
Editor’s Comments
Editor’s CommentsIt’s pretty hard to argue with Dr. Haines’ points. Adding contact force sensing to today’s PFA catheters doesn’t seem justified from a practical viewpoint. But noting how many of this year’s AF Symposium talks featured contact force sensing with PSA, I may be wrong on this.
For more on how PFA works, see Pulsed Field Ablation—Emerging Tech for Atrial Fibrillation.
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Last updated: Thursday, July 18, 2024
