Patent Description:
Tissue ablation is used in various medical procedures, such as in treating arrhythmias in a patient heart by a physician using one or more ablation catheters for generating a lesion at a predefined site within the patient heart. There are different ablation modes, and sometimes during the ablation, the physician may decide to switch from a first ablation mode to a second ablation mode, which is more suitable for obtain the desired lesion.

<CIT> teaches a medical apparatus that includes a probe configured for insertion into a body of a patient and comprising a plurality of electrodes configured to contact tissue within the body. The medical apparatus further includes an electrical signal generator configured to apply between one or more pairs of the electrodes sinusoidal radio-frequency (RF) signals of first and second types in alternation. The signals of the first type have a first voltage sufficient to cause irreversible electrophoresis (IRE) in the tissue contacted by the electrodes and a first power that is insufficient to thermally ablate the tissue, and the signals of the second type have a second power sufficient to thermally ablate the tissue contacted by the electrodes and a second voltage that is insufficient to cause IRE in the tissue.

Any methods of treatment described hereinafter are presented for illustrative purposes only and do not, by themselves, form part of the invention.

The present disclosure will be more fully understood from the following detailed description of the examples thereof, taken together with the drawings in which:.

Various ablation modes, such as but not limited to Pulsed Field Ablation (PFA), and radiofrequency (RF) ablation, may be used for treating arrhythmia in a patient heart using one or more catheters having suitable electrodes. PFA may be used for ablating tissue cells by applying to tissue high-voltage pulses. Cellular destruction occurs when the transmembrane potential exceeds a threshold, leading to cell death and irreversible electroporation (IRE) of the tissue, resulting in the formation of a lesion in a respective section of the heart. In PFA-based ablation procedures, a sequence of microsecond high-voltage electrical pulses is applied to the tissue intended to be ablated, and in RF-based ablation, a lesion is formed by applying to the tissue electrical pulses having a lower electrical power and a longer duration compared to that of PFA, an example of the different ablation parameters is described in <FIG> below.

In some cases, the ablation procedure is carried out along a line, referred to herein as an ablation line, and while applying the ablation pulses along the ablation line, a physician that conducts the ablation may decide to switch between the ablation modes (e.g., from PFA to RF). In such cases, the physician must select a new set of ablation parameters for obtaining the required properties of the lesion. In order to obtain a contiguous lesion having a uniform depth and width along the ablation line, several parameters must be altered. For example, the distance between each pair of ablation points, and contact force between the catheter and the tissue, must be adjusted when switching between PFA-based and RF-based ablation mode. Manual adjustment of the parameters may reduce the quality of the lesion, and may undesirably increase the duration of the ablation procedure.

Examples of the present disclosure that are described hereafter provide techniques for seamless switching between ablation modes by automatically adjusting the suggested ablation parameters in response to switching between ablation modes during a tissue ablation procedure.

In some examples, a system for treating arrhythmia in a patient heart comprises one or more catheters, at least one of the catheters has one or more ablation electrodes configured to apply different types of ablation signals, such as RF ablation signals and PFA ablation signals. The system further comprises a generator configured to generate both types of the ablation signals, and a switching box configured to switch between the PFA-based and RF-based ablation signals applied by the generator.

In some examples, the system comprises a processor, which is configured to receive (e.g., from the physician) a target lesion parameter indicative of a specification of a lesion intended to be formed in the tissue of the heart. For example, the lesion parameters may comprise at least the depth and width of a lesion.

In some examples, the processor is configured to calculate a first set of ablation parameters for the PFA-based ablation mode, and a second set of ablation parameters for the RF-based ablation mode. Alternatively, the processor may select the ablation parameters based on stored data obtained in previous suitable ablation procedures. Note that when the first and second sets of ablation parameters are applied, a lesion having the lesion parameter is expected to be formed in the corresponding location within the patient heart. Examples of lesion parameters and corresponding sets of ablation parameters are described in detail in <FIG> below.

In some cases, at a given ablation point along the ablation line, the physician may toggle between the ablation modes while performing the ablation along the ablation line. In some examples, in response to the toggling, the processor is configured to (i) detect which ablation mode (e.g., PFA or RF) has been selected by the physician, (ii) provide guidance for positioning the catheter at an ablation site based on the ablation mode (e.g., PFA or RF) selected, and (iii) apply to the given ablation point ablation signals corresponding to the selected ablation mode.

The disclosed techniques enable seamless switching between ablation modes along the ablation line without preplanning, and therefore, improve the lesion quality and reduce the duration of ablation procedures.

<FIG> is a schematic, pictorial illustration of a catheter-based electrophysiology mapping and ablation system <NUM>, in accordance with an example of the present disclosure.

In some examples, system <NUM> includes multiple catheters, which are percutaneously inserted by a physician <NUM> through the patient's vascular system into a chamber or vascular structure of a heart <NUM>. Typically, a delivery sheath catheter is inserted into the left or right atrium near a desired location in heart <NUM>. Thereafter, one or more catheters can be inserted into the delivery sheath catheter so as to arrive at the desired location within heart <NUM>. The plurality of catheters may include catheters dedicated for sensing Intracardiac Electrogram (IEGM) signals, catheters dedicated for ablating and/or catheters adapted to carry out both sensing and ablating. An example catheter <NUM> that is configured for sensing IEGM is illustrated herein. In some embodiments, physician <NUM> may place a distal tip <NUM> of catheter <NUM> in contact with the heart wall for sensing a target site in heart <NUM>. Additionally, or alternatively, for ablation, physician <NUM> would similarly place a distal end of an ablation catheter in contact with a target site for ablating tissue intended to be ablated.

In the present example, catheter <NUM> includes one and preferably multiple electrodes <NUM> optionally distributed along a shaft <NUM> at distal tip <NUM> of catheter <NUM>. Electrodes <NUM> and configured to sense the IEGM signals. Catheter <NUM> may additionally include a position sensor <NUM> embedded in or near distal tip <NUM> for tracking position and orientation of distal tip <NUM>. Optionally and preferably, position sensor <NUM> is a magnetic based position sensor including three magnetic coils for sensing three-dimensional (3D) position and orientation.

In some examples, magnetic based position sensor <NUM> may be operated together with a location pad <NUM> including a plurality of (e.g., three) magnetic coils <NUM> configured to generate a plurality of (e.g., three) magnetic fields in a predefined working volume. Real time position of distal tip <NUM> of catheter <NUM> may be tracked based on magnetic fields generated with location pad <NUM> and sensed by magnetic based position sensor <NUM>. Details of the magnetic based position sensing technology are described, for example, in <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>.

In some examples, catheter <NUM> includes a contact force sensor <NUM>, which is configured to sense the contact force applied to tissue of heart <NUM> by distal tip <NUM>, and to produce a signal indicative of the sensed contact force.

In some examples, system <NUM> includes one or more electrode patches <NUM> positioned for skin contact on patient <NUM> to establish location reference for location pad <NUM> as well as impedance-based tracking of electrodes <NUM>. For impedance-based tracking, electrical current is directed toward electrodes <NUM> and sensed at electrode skin patches <NUM> so that the location of each electrode can be triangulated via the electrode patches <NUM>. This technique is also referred to herein as Advanced Current Location (ACL) and details of the impedance-based location tracking technology are described in <CIT>; <CIT>; <CIT>; <CIT>; and <CIT>. In some embodiments, the magnetic based position sensing and the ACL may be applied concurrently, e.g., for improving the position sensing of one or more electrodes coupled to a shaft of a rigid catheter or to flexible arms or splines at the distal tip of another sort of catheter, such as the PentaRay® or OPTRELL® catheters, available from Biosense Webster, Inc. , 31A Technology Drive, Irvine, CA <NUM>.

In some examples, a recorder <NUM> displays electrograms <NUM> captured with body surface ECG electrodes <NUM> and intracardiac electrograms (IEGM) captured with electrodes <NUM> of catheter <NUM>. Recorder <NUM> may include pacing capability for pacing the heart rhythm and/or may be electrically connected to a standalone pacer.

In some examples, system <NUM> may include an ablation energy generator <NUM> that is adapted to conduct ablative energy to one or more of electrodes at a distal tip of a catheter configured for ablating. Energy produced by ablation energy generator <NUM> may include, but is not limited to, radiofrequency (RF) energy or pulse trains of pulsed-field ablation (PFA) energy, including monopolar or bipolar high-voltage DC pulses as may be used to effect irreversible electroporation (IRE), or combinations thereof. In the present example, catheter <NUM> includes an ablation electrode <NUM> but optionally includes multiple electrodes <NUM> (not shown), positioned at distal tip <NUM> and configured to apply the RF energy and/or the pulse trains of PFA energy to tissue of the wall of heart <NUM>.

In some examples, patient interface unit (PIU) <NUM> is an interface configured to establish electrical communication between catheters, electrophysiological equipment, power supply and a workstation <NUM> for controlling the operation of system <NUM>. Electrophysiological equipment of system <NUM> may include for example, multiple catheters, location pad <NUM>, body surface ECG electrodes <NUM>, electrode patches <NUM>, ablation energy generator <NUM>, and recorder <NUM>. Optionally and preferably, PIU <NUM> additionally includes processing capability for implementing real-time computations of location of the catheters and for performing ECG calculations.

In some examples, workstation <NUM> includes a storage device, a processor <NUM> with suitable random-access memory, or storage with appropriate operating software stored therein, an interface <NUM> configured to exchange signals of data (e.g., between processor <NUM> and another entity of system <NUM>) and user interface capability. Workstation <NUM> may provide multiple functions, optionally including (<NUM>) modeling the endocardial anatomy in three-dimensions (3D) and rendering the model or anatomical map <NUM> for display on a display device <NUM>, (<NUM>) displaying on display device <NUM> activation sequences (or other data) compiled from recorded electrograms <NUM> in representative visual indicia or imagery superimposed on the rendered anatomical map <NUM>, (<NUM>) displaying real-time location and orientation of multiple catheters within the heart chamber, and (<NUM>) displaying on display device <NUM> sites of interest such as places where ablation energy has been applied. One commercial product embodying elements of the system <NUM> is available as the CARTO™ <NUM> System, available from Biosense Webster, Inc. , 31A Technology Drive, Irvine, CA <NUM>.

In some examples, processor <NUM> receives from contact force sensor <NUM> a signal indicative of the contact force applied between ablation electrode <NUM> and the tissue intended to be ablated. Moreover, processor <NUM> may store one or more contact force thresholds in order to provide physician <NUM> with an indication of whether the contact force applied between ablation electrode <NUM> and the tissue intended to be ablated is sufficient for the planned ablation mode (e.g., a first threshold for RF-based ablation mode, and a second different threshold for PFA-based ablation mode).

<FIG> is a schematic, pictorial illustration of annotations <NUM> and <NUM> that are indicative of PFA energy and RF energy applied to the tissue of heart <NUM>, respectively, and are superimposed over anatomical map <NUM>, in accordance with an example of the present disclosure.

In the example of <FIG>, a plurality of annotations <NUM> and an annotation 44a are indicative of the ablation event in response to the PFA energy used for ablating tissue cells of heart <NUM>. Similarly, a plurality of annotations <NUM> and an annotation 66a are indicative of the lesion formed in response to the RF energy used for ablating tissue cells of heart <NUM>. Note that annotations <NUM> and 44a are similar and annotations <NUM> and 66a are similar and the index "a" of annotations 44a and 66a is used herein for the sake of presentation clarity, as will be described below.

In PFA-based ablation, cellular destruction of the tissue occurs when the transmembrane potential exceeds a threshold, which leads to cell death and irreversible electroporation (IRE) of the tissue and results in the formation of a lesion in a section <NUM> of the wall tissue of heart <NUM>. In PFA-based ablation procedures, a sequence of microsecond high-voltage electrical pulses is applied to the tissue of section <NUM>.

In response to applying RF energy, also referred to herein as RF ablation or RF-based ablation mode, a lesion is formed by applying to the tissue electrical pulses having, compared to that of PFA, a lower electrical power and a longer duration, an example of the different ablation parameters is described below.

Both ablation modes are used to form in the tissue a lesion, but the properties of the lesion may depend on the ablation mode (e.g., PFA-based or RF-based ablation) used for producing them. Moreover, both ablation modes may be carried out by applying the pulses using a unipolar (also referred to herein as monopolar) ablation or using a bipolar ablation (e.g., between two ablation electrodes, in case catheter <NUM> has two or more ablation electrodes <NUM>). In the present example, the unipolar ablation may be carried out between ablation electrode <NUM> coupled to shaft <NUM> of catheter <NUM> and an indifferent electrode (e.g., one of electrode patches <NUM>). Additionally, or alternatively, system <NUM> may have any other type of catheter suitable for ablating the tissue and having ablation electrodes, such as but not limited to electrodes <NUM>. Note that the examples of the present disclosure that are described below, are applicable for focal catheter <NUM> and, mutatis mutandis, for other suitable type of catheters, such as a basket catheter, a balloon catheter, a lasso catheter, and other suitable types of catheters having ablation electrodes.

In some cases, the ablation procedure is carried out along sections <NUM> and <NUM>, also referred to herein as ablation lines, and while applying the ablation energy, physician <NUM> that conducts the ablation may decide to switch between the ablation modes (e.g., from PFA-based to RF-based). In this example, when moving ablation electrode <NUM> from section <NUM> to section <NUM>, physician <NUM> must select a new set of ablation parameters for obtaining the required properties of the lesion. In order to obtain a contiguous lesion having a uniform depth and width along the ablation line, several parameters must be altered between sections <NUM> and <NUM>. For example, the voltage and power, pulse duration, number of pulses, and the contact force between distal tip <NUM> of shaft <NUM> and the tissue must be adjusted when switching between PFA-based and RF-based ablation modes. It is noted that manual adjustment of these parameters may reduce the quality of the lesion (e.g., due to usage of non-optimal ablation conditions), and may increase the duration of the ablation procedure.

Examples of the present disclosure that are described below provide techniques for automatically adjusting the ablation parameters in response to switching between ablation modes (e.g., between PFA-based and RF-based ablation modes and vice versa) during tissue ablation procedure.

In some examples, ablation electrode <NUM> is configured to apply both RF energy and PFA energy to the tissue of heart <NUM>. In an example configuration, system <NUM> comprises a PFA pulse generator (PPG) and a RF pulse generator that in the present example are incorporated in a single generator, referred to herein as a generator <NUM>. In another example configuration, system <NUM> may comprise two separate generators, a PPG for applying the PFA energy and a different generator for applying the RF energy. In both configurations, system <NUM> may comprise a switching box (not shown) configured to switch between the PFA-based and RF-based ablation modes.

In some examples, display device <NUM> is configured to receive from physician <NUM> (e.g., using a graphical user interface displayed thereon) one or more lesion parameters, which are transferred to interface <NUM> implemented in workstation <NUM> as described in <FIG> above. In the present example, the lesion parameters are indicative of a specification of the lesion intended to be formed in sections <NUM> and <NUM> of the tissue of heart <NUM>. For example, the lesion parameters comprise at least one of a lesion depth (e.g., about <NUM>), and a lesion width (e.g., between about <NUM> and <NUM>). In other examples, physician <NUM> can choose pre-defined types of lesion parameters (e.g., shallow, medium, and deep ablation), and responsively, processor <NUM> selects ablation parameters that match this level for each of the RF-based and PFA-based ablation modes. Moreover, when using specific types of ablation catheters (e.g., catheters having multiple ablation electrodes, such as electrodes <NUM>, arranged along one or more splines or along a balloon), the lesion parameter may be indicative of the continuity of the lesion.

In some examples, based on the lesion parameters, processor <NUM> is configured to calculate (i) a first set of ablation parameters for the PFA-based ablation mode, and (ii) a second set of ablation parameters for the RF-based ablation mode. In other examples, processor <NUM> may have one or more stored lookup tables based on empirical data from previous ablation procedures, and based of the selected lesion parameter, processor <NUM> selects the first set of ablation parameters for the PFA-based ablation mode, and the second set of ablation parameters for the RF-based ablation mode.

In the example of <FIG>, the first set of ablation parameters is applied to the tissue along the ablation line of section <NUM>, and the second set of ablation parameters is applied to the tissue along the ablation line of section <NUM>. Note that the first and second sets of ablation parameters are intended to form along sections <NUM> and <NUM>, respectively, a lesion having the aforementioned lesion parameters defined by physician <NUM>.

For example, physician <NUM> may define lesion parameters comprising a lesion depth of about <NUM> and a lesion width of about <NUM> along section <NUM>. In this example, processor <NUM> selects and/or calculates ablation parameters for the RF-based ablation mode, such as power, duration, contact force, temperature, and distance between ablation points. For example, a pulse amplitude of about <NUM> watts (or any other suitable power between about <NUM> watts and <NUM> watts), which is applied to the tissue for about <NUM> seconds (or for any other suitable time interval between about <NUM> seconds and <NUM> seconds).

Similarly, physician <NUM> may define the same <NUM> depth and <NUM> width along section <NUM>. In this example, processor <NUM> is configured to calculate ablation parameters for the PFA-based ablation mode, such as but not limited to number of pulses in a train, number of trains, pulse amplitude, and distance between ablation points. For example, a voltage amplitude of about <NUM> volts (or any other suitable voltage between about <NUM> volts and <NUM> volts), which is applied to the tissue for about <NUM> milliseconds (or for any other suitable time interval between about <NUM> milliseconds and <NUM> milliseconds). Note that the <NUM> milliseconds time interval of the PFA energy comprises multiple sequential pulse trains having respective time intervals of about <NUM> microseconds, each pulse train comprising a sequence of multiple pulses applied to the tissue for a time interval between about <NUM> microseconds and <NUM> microseconds. Typically, the distance in RF-based ablation mode is larger compared to that of the PFA-based ablation mode. Processor <NUM> may display, over display device <NUM>, the distance from the previous ablation point, and lets physician <NUM> know at what distance to set the next ablation point. When physician <NUM> switches the ablation mode, processor <NUM> automatically switches the instruction for where to place the next ablation point. For example, if physician <NUM> switches from RF-based to PFA-based ablation mode, processor <NUM> reduces the suggested distance between the previous and the next ablation points. The distance between adjacent ablation points is important for obtaining a contiguous lesion having a uniform depth and width.

Note that after defining the <NUM> depth and <NUM> width of the lesion size, physician <NUM> can switch at will between RF-based and PFA-based ablation modes, without preplanning, and processor <NUM> controls generator <NUM> to apply to electrode <NUM> the respective set of ablation parameter corresponding to the selected ablation mode and also adjusts the indications provided on the GUI that guides the physician in performing the next ablation. Guidance may include for example guiding the physician in placing the catheter at the next ablation site (at a recommended distance from adjacent ablation site) as well as placing the catheter against the tissue with the recommended contact force.

In some examples, processor <NUM> is configured to display over display device <NUM>, a toggle switch for toggling between PFA-based and RF-based ablation modes. When conducting the ablation procedure along the ablation lines comprising section <NUM> and <NUM>, physician <NUM> may: (i) select the PFA-based ablation mode in the toggle switch, and use catheter <NUM> for applying to section <NUM> the PFA energy (also referred to herein as a first ablation mode), and subsequently, (ii) select the RF-based ablation mode in the toggle switch, and use catheter <NUM> for applying to section <NUM> the RF energy (also referred to herein as a first ablation mode). Note that physician <NUM> starts the tissue ablation at the uppermost point of section <NUM> on the wall tissue of heart <NUM>, and the transition between the first and second ablation modes is carried out at the interface between sections <NUM> and <NUM>, in the present example, between the locations of annotations 44a and 66a.

In some examples, after concluding the ablation at the point corresponding to annotation 44a and before performing the ablation at the point corresponding to annotation 66a, physician <NUM> toggles the ablation mode from the PFA-based to the RF-based ablation mode. Note that each of annotations <NUM>, 44a, <NUM> and 66a is typically displayed over anatomical map <NUM> after performing the ablation. A GUI indication may be provided to the physician to guide the physician as to where to place the next ablation. Optionally, during PFA shorter distances between ablation sites shown as annotations <NUM> is recommended as compared to during RF ablation shown as annotations <NUM>. The indicated recommendation may be adjusted based on detecting a switch. Optionally, the recommended position of ablation site, referred to herein as annotation 66a, in relation to ablation site of annotation 44a may be pre-defined and indicated to the physician based on detecting the switch.

In some examples, processor <NUM> is configured to detect the switched ablation mode (e.g., from PFA-based to RF-based ablation mode), and responsively, to apply the set of parameters of RF energy to the ablation sites of section <NUM>, so as to obtain the predefined lesion parameters (e.g., the lesion depth of about <NUM> and the lesion width of about <NUM>) in section <NUM>. In other words, from the ablation point corresponding to annotation 66a, and along section <NUM>, processor <NUM> controls catheter <NUM> to apply to the wall tissue of heart <NUM> RF energy via catheter <NUM> and electrode <NUM>.

In some examples, display device <NUM> is configured to display (i) anatomical map <NUM>, (ii) the lesion parameters (determined by physician <NUM>) and the corresponding ablation parameters (determined by processor <NUM>) for each ablation mode, and (iii) annotations <NUM> and <NUM> (e.g., ablation tags) indicative of the ablation event at that location.

<FIG> is a flow chart that schematically illustrates a method for seamless switching between PFA-based and RF-based ablation modes, in accordance with an example of the present disclosure.

The method begins at a lesion specification definition step <NUM>, with physician <NUM> determining the specification of the lesion intended to be formed along sections <NUM> and <NUM> of the tissue of heart <NUM>. For example, lesion depth of about <NUM> and lesion width of about <NUM>, as described in detail in <FIG> above.

At a preliminary ablation parameter setting step <NUM>, processor <NUM> selects (e.g., from the aforementioned storage device of workstation <NUM>) first and second sets of predefined (e.g., default) ablation parameters for the PFA-based and the RF-based ablation modes, respectively, as described in <FIG> above.

At a detection step <NUM>, processor <NUM> detects that physician <NUM> has selected the PFA-based ablation mode in the toggle switch, as described in detail in <FIG> above.

At an ablation parameter adjustment setting step <NUM>, processor <NUM> calculates the ablation parameters (e.g., of the PFA-based ablation mode) that when applied to the tissue, are expected to obtain the lesion specification determined by physician <NUM> in step <NUM> above.

At an ablation step <NUM>, processor <NUM> controls generator <NUM> and catheter <NUM> to apply signals of PFA-based energy to the tissue at the ablation points of section <NUM>. Note that the signals of PFA-based energy are selected and adjusted (e.g., calculated) at steps <NUM> and <NUM>, respectively, and optionally, processor <NUM> is further configured to display the ablation parameters of the of PFA-based energy on display device <NUM>, so that physician <NUM> and any other suitable user of system <NUM> could see the calculated ablation parameters.

At a decision step <NUM> that in the present example is carried out after concluding the ablation at the position of annotation 44a, physician <NUM> decided whether s/he wants to switch the ablation mode, e.g., from PFA-based to RF-based, at the position of annotation 66a. Note that the switching between the ablation modes may not be preplanned, and physician <NUM> may decide to toggle between the ablation modes during the procedure (or alternatively, prior to the procedure). In case physician <NUM> decides to switch the ablation mode, the method loops back to step <NUM> and processor <NUM> (i) detects that physician <NUM> has toggled from PFA-based to RF-based ablation mode, (ii) calculates the ablation parameters as described in step <NUM> above, and (iii) controls generator <NUM> and catheter <NUM> to apply the RF energy to section <NUM> of the tissue, based on the ablation parameters calculated in step <NUM>.

At an ablation termination step <NUM> that concludes the method, after switching to the RF-based ablation mode and concluding the ablation of section <NUM>, processor <NUM> displays annotations <NUM> and <NUM> and controls generator <NUM> to stop applying the ablation energy to catheter <NUM>.

Alternatively, at decision step <NUM> physician <NUM> may decide to continue the ablation by applying PFA energy also to section <NUM>. In this example, processor <NUM> is configured to retain the ablation parameters of the PFA-based ablation mode, and display annotations <NUM> and <NUM> in accordance with the progress of the ablation procedure. Moreover, after concluding the ablation in sections <NUM> and <NUM>, processor <NUM> controls generator <NUM> to stop applying the ablation energy to catheter <NUM>.

Although the examples described herein mainly address electrophysiology procedures applying RF ablation energy and pulse trains of PFA energy to tissue of the heart wall of heart <NUM>, the methods and systems described herein can also be used in other applications, such as in any other switching between different operating modes that include applying signals to any suitable organ of a patient.

Claim 1:
A system (<NUM>), comprising:
an interface (<NUM>), which is configured to receive a lesion parameter indicative of a specification of a lesion intended to be formed in tissue of an organ (<NUM>) using at least one of first and second ablation modes intended to be applied sequentially to multiple sections (<NUM>, <NUM>) of the tissue; and
a processor (<NUM>), which is configured to (i) select, for the first and second ablation modes, first and second sets of parameters, respectively, that when applied to the tissue, form the lesion having the lesion parameter, (ii) detect, for a section selected among the multiple sections (<NUM>, <NUM>), whether the first or second ablation mode has been selected, and (iii) control a catheter (<NUM>) having at least an ablation electrode (<NUM>), to apply to the section ablation signals that are based on the selected ablation mode and are corresponding to the first or second ablation modes.