Programa del congreso

Atrial fibrillation (AF) is the most common cardiac arrhythmia, but current ablation therapies remain limited. Epicardial pulsed field ablation (PFA) is a novel strategy targeting ganglionated plexi (GPs) within epicardial fat. Although promising, prior computational models lacked clinical realism, as they excluded catheter geometry, clinical ablation protocols, hemodynamics, and thermal latency. We developed a 3D model incorporating a commercially available catheter, clinically relevant PFA settings (60 pulses, 100 µs, 1 Hz), and fully coupled electrical-thermal-fluid dynamics problem. The anatomy included epicardial fat, myocardium, blood, and the left circumflex artery (LCx) with a stent positioned beneath the catheter to reproduce worst-case conditions. Tissue conductivity was modelled as dependent on electric field and temperature, while blood and saline flow were simulated at physiological rates. Simulations tested 1000, 2000, and 2500 V, with outcomes including lesion volume, peak temperature, and Arrhenius-based thermal damage over a 90-s latency. Fat lesion volume was largest without an artery (490 mm³) and reduced in its presence (390 mm³). The stent shielded the lumen but did not significantly alter fat ablation. Myocardial involvement occurred only at 2500 V. At 1000 V, peak temperatures remained <40 °C with negligible thermal damage. At higher voltages, fat and arterial wall heating increased, with the stent slightly enhancing arterial wall temperatures. Thermal damage expanded during latency, reaching up to fivefold larger volumes in fat at 2500 V. In conclusion, epicardial PFA at 1000 V appears safe and effective, even near stented arteries, whereas higher voltages increase the risk of thermal collateral damage.