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Dos Santos Sousa IB, Chokr MO, Melo SL, Pisani CF, Hardy CA, de Moura LG, Sacilotto L, Wu TC, Darrieux FCC, Scanavacca MI. Comparison between cryotherapy and radiofrequency energy sources for parahisian accessory pathway percutaneous ablation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01841-8. [PMID: 38833098 DOI: 10.1007/s10840-024-01841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Catheter ablation of parahisian accessory pathways (PHAP) are challenging due to their proximity to the normal conduction system. Retrospective studies suggest that cryoablation has a better safety profile but a higher recurrence rate when compared to radiofrequency ablation (RFCA). The objective of this study was to compare the results of parahisian AP ablation performed by electrophysiologists with experience in both technologies. METHODS Prospective single-center, non-blinded and 1:1 model was used. Patients included had parahisian AP confirmed by an electrophysiological study and referred for radiofrequency or cryotherapy ablation according to current guidelines, under fluoroscopic guidance. No electroanatomic mapping was used. RESULTS A total of 30 patients (mean age of 25±9.4 years; 90% male) were enrolled between Oct/2018 to Feb/2020. Acute success rate between RFCA and CRYO were similar (93% vs. 87%, p = 0.54). A nonsignificant reduction in short-term recurrence rate for RFCA (14% vs. 30%, p = 0.3) and mechanical trauma (6% vs. 20%; p = 0.28) was observed. Long-term recurrence rate and event-free survival time were similar in both groups after 1-year follow-up (p = 0.286). No persistent complete AV block or conduction disturbance was also observed. CONCLUSION Considering the limitation of a small sample size and the lack of use of electroanatomic mapping for RFCA, the efficacy and safety profile of parahisian AP ablation with RFCA was not different from CRYO, when performed by experienced electrophysiologists. No cases of permanent complete AV block were reported with either energy modalities.
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Affiliation(s)
- Italo Bruno Dos Santos Sousa
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.
| | - Muhieddine Omar Chokr
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Sissy Lara Melo
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Cristiano Faria Pisani
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Carina Abigail Hardy
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Lucas Goyanna de Moura
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Luciana Sacilotto
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Tan Chen Wu
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | | | - Mauricio Ibrahim Scanavacca
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
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2
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Drago F, Flore F, Tamborrino PP, Silvetti MS, Maiolo S, Raponi M. Trans-jugular approach for safe and successful cryoablation of para-Hisian/anterior-septal, anterior, and anterior-lateral accessory pathways in children. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01807-w. [PMID: 38642206 DOI: 10.1007/s10840-024-01807-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Cryoablation of APs localized near the atrioventricular (AV) junction is a well-established ablation strategy in children, and it has proved to be very safe. However, recurrence rates remain considerable for specific accessory pathway (AP) localizations. The aim of this retrospective study was to evaluate the efficacy and safety of a trans-jugular approach for cryoablation of right anterior, anterior-lateral, and anterior-septal APs in children, as compared to the conventional femoral approach. METHODS From June 2019 to November 2023, 24 consecutive patients (mean age 13.2 ± 4.6, 12 males (50% of total cohort)) with right anterior-lateral, anterior, and anterior-septal/para-Hisian APs underwent 3D non-fluoroscopic transcatheter cryoablation through the right jugular vein at our Institution. Ablation results were compared with 24 patients for whom a conventional trans-femoral approach was used. RESULTS Acute procedural success rate was 100% (n = 24/24), with a non-statistically significant difference as compared to the control group (100% vs. 83%, p = 0.1). During follow-up (1.1 years, interquartile range 0.6-1.3), one patient (4%) had a recurrence in the trans-jugular group, as opposed to eight (38%) in the control group (p = 0.006). No permanent complications occurred. CONCLUSIONS 3D cryoablation of right anterior-lateral, anterior, and anterior-septal/para-Hisian APs in children using a trans-jugular approach is extremely effective and safe, resulting in higher chronic success rate compared to the conventional femoral approach.
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
| | - Francesco Flore
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Pietro Paolo Tamborrino
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Stella Maiolo
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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3
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Leung LW, Evranos B, Gonna H, Harding I, Domenichini G, Gallagher MM. Multi-catheter cryotherapy for the treatment of resistant accessory pathways. Indian Pacing Electrophysiol J 2024; 24:1-5. [PMID: 37977548 PMCID: PMC10927982 DOI: 10.1016/j.ipej.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter ablation. BACKGROUND Catheter ablation is established in the treatment of accessory pathways (AP), with high rates of permanent procedural success with a single attempt. However, there are still instances of acute procedural failure and AP recurrences with standard RF and cryotherapy methods. METHODS Seven consecutive cases of pre-excitation syndromes with prior failed RF catheter ablation had the novel treatment. Cryotherapy was delivered using two 8 mm tip focal cryoablation catheters (Freezor® Max, Medtronic, Minneapolis, Minnesota, USA). RESULTS Accessory pathway localisation was septal in 5 cases, left posterolateral in 1, right lateral in 1. In all cases, ablation of the AP was acutely successful with no procedural complications. Median procedure and fluoroscopy durations were 199 and 35 min, sequentially. Median Procedure duration fell significantly in the second half of series (174 min) compared to the first half (233 min, P = 0.05). One patient had evidence of a recurring AP conduction with pre-excitation at 5-week follow up. After a median follow up of 66.8+-6.5 months, 6 out of 7 patients remained asymptomatic and free of pre-excitation. CONCLUSION Simultaneous multi-catheter cryotherapy is feasible, safe and can provide definitive cure of accessory pathways that were previously resistant to standard radiofrequency ablation. Further study is required in the assessment of this novel form of advanced cryotherapy to treat complex and resistant arrhythmias.
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Affiliation(s)
- Lisa Wm Leung
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Banu Evranos
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Hanney Gonna
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Idris Harding
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Giulia Domenichini
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Mark M Gallagher
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK.
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4
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Patel T, Li C, Raissi F, Kassab GS, Gao T, Lee LC. Coupled thermal-hemodynamics computational modeling of cryoballoon ablation for pulmonary vein isolation. Comput Biol Med 2023; 157:106766. [PMID: 36958236 DOI: 10.1016/j.compbiomed.2023.106766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/26/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
Cryoballoon ablation (CBA) is a cryo-energy based minimally invasive treatment procedure for patients suffering from left atrial (LA) fibrillation. Although this technique has proved to be effective, it is prone to reoccurrences and some serious thermal complications. Also, the factors affecting thermal distribution at the pulmonary vein-antrum junction that are critical to the treatment success is poorly understood. Computer modeling of CBA can resolve this issue and help understand the factors affecting this treatment. To do so, however, numerical challenges associated with the simulation of advection-dominant transport process must be resolved. Here, we describe the development of a thermal-hemodynamics computational framework to simulate incomplete occlusion in a patient-specific LA geometry during CBA. The modeling framework uses the finite element method to predict hemodynamics, thermal distribution, and lesion formation during CBA. An incremental pressure correction scheme is used to decouple velocity and pressure in the Navier-Stokes equation, whereas several stabilization techniques are also applied to overcome numerical instabilities. The framework was implemented using an open-source FE library (FEniCS). We show that model predictions of the hemodynamics in a realistic human LA geometry match well with measurements. The effects of cryoballoon position, pulmonary vein blood velocity and mitral regurgitation on lesion formation during CBA was investigated. For a -700C cryoballoon temperature, the model predicts lesion formation for gaps less than 2.5 mm and increasing efficiency of CBA for higher balloon tissue contact areas. The simulations also predict that lesion formation is not sensitive to variation in pulmonary vein blood velocity and mitral regurgitation. The framework can be applied to optimize CBA in patients for future clinical studies.
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Affiliation(s)
- Tejas Patel
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Chris Li
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Farshad Raissi
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - Tong Gao
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA; Department of Computational Mathematics, Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA.
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5
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Li GY, Chung FP. Cryoballoon Ablation for Ventricular Arrhythmias: Prospects and Challenges. HeartRhythm Case Rep 2022; 9:208-209. [PMID: 37101666 PMCID: PMC10123926 DOI: 10.1016/j.hrcr.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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6
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Noten AME, Kammeraad JAE, Ramdat Misier NL, Wijchers S, van Beynum IM, Dalinghaus M, Krasemann TB, Yap SC, de Groot NMS, Szili-Torok T. Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation. IJC HEART & VASCULATURE 2021; 37:100881. [PMID: 34646933 PMCID: PMC8495098 DOI: 10.1016/j.ijcha.2021.100881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/17/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
Background Catheter ablation (CA) is the first-choice treatment for tachyarrhythmia in children. Currently available CA techniques differ in mechanism of catheter navigation and energy sources. There are no large studies comparing long-term outcomes between available CA techniques in a pediatric population with atrioventricular reentry tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms. Objective This study aimed to compare procedural and long-term outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO). Methods This single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT performed in children without structural heart disease from 2008 to 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was long-term recurrence of tachyarrhythmia. Results In total, we included 223 patients, aged 14 (IQR 12-16) years; weighting 56 (IQR 47-65) kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using CRYO. RMN had significantly lower recurrence rates compared to MAN and CRYO at mean follow-up of 5.5 ± 2.9 years (AVRT: 4.3% versus 15.6% versus 54.5%, P < 0.001; AVNRT: 7.7% versus 8.3% versus 35.7%, P = 0.008; for RMN versus MAN versus CRYO respectively). In AVNRT ablation, RMN had significantly lower fluoroscopy doses compared to CRYO [30 (IQR 20-41) versus 45 (IQR 29-65) mGy, P = 0.040). Conclusion In pediatric patients without structural heart disease who underwent their first AV(N)RT ablation, RMN has superior long-term outcomes compared to MAN and CRYO, in addition to favorable fluoroscopy doses.
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Key Words
- AP, accessory pathway
- AVNRT, atrioventricular nodal reentry tachycardia
- AVRT, atrioventricular reentry tachycardia
- Atrioventricular nodal reentry tachycardia
- Atrioventricular reentry tachycardia
- CA, catheter ablation
- CHD, congenital heart defect
- CRYO, cryoablation
- Catheter ablation
- Cryoablation
- DAP, dose area product
- EAM, electro-anatomic mapping
- ECG, electrocardiogram
- MAN, manual
- Pediatrics
- RF, radiofrequency
- RMN, remote magnetic navigation
- Radiofrequency ablation
- Remote magnetic navigation
- SVT, supraventricular tachycardia
- Supraventricular tachycardia
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Affiliation(s)
- Anna M E Noten
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Nawin L Ramdat Misier
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sip Wijchers
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Ingrid M van Beynum
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Thomas B Krasemann
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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7
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Valdigem BP, Silva NJCD, Andalaft RB, Almeida C, Araujo Junior N, Scazzuso F, Souza OFD. Cryoablation of a Mahaim Epicardial Accessory Pathway Inside Coronary Sinus Using an 8-mm Catheter. JOURNAL OF CARDIAC ARRHYTHMIAS 2021. [DOI: 10.24207/jca.v34i2.3445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Cyoablation is a ablation technique underutilized except in parahissian pathways and atrial fibrillation ablation. Ablation inside venous coronary sinus remains a dreaded incursion, and cryoablation is rarely used. We present the case of a 43 YO female who had a recurrent wolff parkinson white syndrome due to an epicardial pathway inside the coronary sinus successfully treated with a large bore(8mm) cryocatheter. We also review literature and describe the advantages and similar reports of use of cryo in low flow recesses inside the heart.
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8
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Calzolari V, De Mattia L, Basso F, Crosato M, Scalon A, Squasi PAM, Del Favero S, Cernetti C. Ablation catheter orientation: In vitro effects on lesion size and in vivo analysis during PVI for atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1554-1563. [PMID: 33111985 DOI: 10.1111/pace.14106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Catheter-delivered radiofrequency (RF) lesion formation is a complex phenomenon, and few studies have explored the effect of catheter orientation on lesion size and catheter orientation behavior during pulmonary vein isolation (PVI) procedures. We evaluated the influence of catheter orientation on lesion dimensions in an in vitro experimental setting and investigated the catheter orientation behavior during PVI. METHODS AND RESULTS 72 lesions were created in vitro on a porcine heart using a contact force catheter in a parallel, oblique, and perpendicular tip to tissue orientation. The superficial lesion length (SLL) increased shifting the catheter from perpendicular to parallel orientation. The intratissue absolute maximal lesion length (AML) was greater with an oblique catheter orientation. The lesion depth (LD) and the superficial lesion width (SLW) resulted similar with any orientation. Data from 21 PVI procedures in patients with paroxysmal atrial fibrillation using the "wide antral circumferential RF ablation" (WACA) technique were retrospectively analyzed. The mean contact angle among 1130 RF lesions was 28 ± 20°. A prevalent parallel orientation was noted in the anterior WACA segments, whereas it resulted more perpendicular in the posterior segments. Significant differences in catheter orientation between the three operators were found only in few WACA segments. CONCLUSIONS In an in vitro setting, catheter orientation affects SLL and AML, but not LD and SLW. During PVI procedures, catheter orientation resulted mostly parallel to the endocardium. Catheter orientation varied among different WACA segments, but only small differences were found between three operators when considering similar WACA segments.
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Affiliation(s)
| | - Luca De Mattia
- Department of Cardiology, Cà Foncello Hospital, Treviso, Italy
| | | | - Martino Crosato
- Department of Cardiology, Cà Foncello Hospital, Treviso, Italy
| | | | | | | | - Carlo Cernetti
- Department of Cardiology, Cà Foncello Hospital, Treviso, Italy
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9
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Mehta N, Morgaenko K, Sauer W, Stevenson W, Haines D. Impact of Variableorientation and Flow Rates on Radiofrequency Ablation Lesions Created by Externally Irrigated Catheters: An Ex-Vivo Study. J Atr Fibrillation 2020; 13:2353. [PMID: 34950307 DOI: 10.4022/jafib.2353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/03/2020] [Accepted: 07/09/2020] [Indexed: 11/10/2022]
Abstract
The impact of variability in irrigation rates and catheter orientation on radiofrequency ablation (RF) lesion creation has not been studied systematically for the uniformly irrigated 56-pore (56P) catheter. This study aimed to analyze the impact of irrigation flow rates (IFRs) and catheter orientation (CO) settings on RF lesions sizes produced by a 56P irrigation catheter in a power-controlled mode using an ex-vivo model. RF lesions were created in strips of chicken muscle in a saline bath heated to 37°C with 56P and 6P catheters using low flow rate (LFR) at 2 cc/min and standard flow (SFR) irrigation rates at 8 cc/min for 56P and 17 cc/min for 6P with horizontal (HO) and vertical (VO) catheter orientations. Ablation power of 20W was delivered for 30 seconds with a mean contact force of 10 g. Sixty RF lesions were analyzed. For the 56P catheter, in contrast to the 6P catheter lesion geometry was independent of CO and IFR in our model. Although 6P catheter had slightly deeper lesions, the overall lesion volumes were similar for 6P and 56P catheters. CO and IFR appeared to have minimal impact on lesion volume creation with 56P catheter. In head-to-head comparison the 6P and 56P irrigated catheters performed similarly.
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Affiliation(s)
- Nishaki Mehta
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Katerina Morgaenko
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - William Sauer
- Brigham and Women's Hospital, Boston, Massachusetts, Vanderbilt Health System, Nashville, Tennessee
| | - William Stevenson
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Virginia.,Brigham and Women's Hospital, Boston, Massachusetts, Vanderbilt Health System, Nashville, Tennessee.,Beaumont Hospital, Oakland University of Medicine, Michigan
| | - David Haines
- Beaumont Hospital, Oakland University of Medicine, Michigan
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10
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Kafalı HC, Özgür S, Şahin GT, Akay EÖ, Güzeltaş A, Ergül Y. Cryoablation with an 8-mm tip catheter for typical AVNRT in children: a single center 5-year experience. J Interv Card Electrophysiol 2020; 62:113-122. [PMID: 32968865 DOI: 10.1007/s10840-020-00868-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In children with typical atrioventricular nodal reentrant tachycardia (tAVNRT), cryoablation is preferred over radiofrequency ablation (RFA) because of its safety profile and acceptable long-term success rates. In this study, we have assessed the utility of 8-mm tip cryocatheters for tAVNRT ablation in our center. METHODS All pediatric AVNRT patients who underwent cryoablation with an 8-mm tip cryocatheter in our center between 2013 and 2018 were included. EnSite™ (St. Jude Medical Inc., St. Paul, MN, USA) was used in all patients. RESULTS A total of 120 patients (64 females, 53%) were included in this study, and the mean age was 13.9 years with a standard deviation of 2.5 years. Eleven patients (9.1%) had structural heart disease, and 12 patients (10%) had additional arrhythmia substrate. The mean number of effective cryolesions was 8 with a standard deviation of 2.3. Fluoroscopy was used in three patients (2.5%). There were minor complications in only four patients (3.3%)-transient first-degree atrioventricular block or transient incomplete right bundle branch block. Acute success rate of cryoablation was 108/120 (90%). In twelve patients, cryoablation was suboptimal, or it failed. The procedure was completed successfully with RFA in the same session in ten patients. Overall acute success rate of ablation (Cryo ± RFA) was 98.5%. During a mean follow-up period of 24.6 months with a standard deviation of 11.3 months, three patients had recurrence (2.5%). Time between the beginning of the effective cryolesion and termination of AVNRT was found associated with acute success of cryoablation (p = 0.013). CONCLUSIONS Cryoablation of AVNRT with an 8-mm tip catheter in children appears to be safe, with an acceptable acute success rate and a low recurrence rate. A faster termination of AVNRT during the cryolesion, slowing down before ending with atrioventricular block, is a good indicator for acute success.
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Affiliation(s)
- Hasan Candaş Kafalı
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey. .,Istanbul Sağlık Bilimleri Universitesi Mehmet Akif Ersoy Eğitim Araştırma Hastanesi, Istasyon Mahallesi İstanbul Caddesi Bezirganbahçe Mevki, 34303, Küçükçekmece/İstanbul, Turkey.
| | - Senem Özgür
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Gülhan Tunca Şahin
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Elif Özkilitçi Akay
- Department of Anesthesiology and Reanimation, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Alper Güzeltaş
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Yakup Ergül
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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Abstract
Objective: The use of fluoroscopy in pediatric catheter ablation has decreased because of mapping systems. In this study, we present the efficiency and reliability of the electroanatomic mapping system in nonfluoroscopic pediatric catheter ablation. Methods: The medical records of patients aged <18 years who underwent ablation between November 2016 and April 2018 were evaluated. Fluoroscopy was not used in cases involving ablation of right sided-arrhythmia foci. Fluoroscopy was used only for trans-septal puncture or retroaortic approach/coronary angiography. Results: A total of 76 patients underwent catheter ablation for 78 supraventricular and ventricular tachyarrhythmia substrates under the guidance of EnSite Velocity system. Fluoroscopy was used in only 14 (18.4%) of these substrates. The mean fluoroscopy duration in these 14 procedures was 5.4±3.15 min. No complications were noted, except a temporary right bundle branch block in one patient and pericardial effusion in another following cryoablation. The acute success rate in achieving complete elimination of arrhythmia substrates was 97.4% (76/78). The recurrence rate was 5.1% (4/78) at follow-up. Conclusion: Fluoroscopy can be completely eliminated in most pediatric catheter ablation procedures with the use of mapping systems by achieving high acute success rates and acceptable low complication rates.
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12
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Determination of cryothermal injury thresholds in tissues impacted by cardiac cryoablation. Cryobiology 2017; 75:125-133. [DOI: 10.1016/j.cryobiol.2017.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/29/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022]
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13
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Tanidir IC, Ergul Y, Ozturk E, Dalgic F, Kiplapinar N, Tola HT, Akdeniz C, Tuzcu V. Cryoablation with an 8-mm-Tip Catheter for Right-Sided Accessory Pathways in Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:797-804. [PMID: 27197083 DOI: 10.1111/pace.12892] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 03/08/2016] [Accepted: 04/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cryoablation is increasingly utilized in children because of its safety profile. Recently, larger catheter tips have been more widely used to improve long-term success rates. The aim of this study was to assess the safety and efficacy of 8-mm-tip catheters for cryoablation of right-sided accessory pathways (APs) in children. METHODS Electrophysiological procedures were performed using the EnSite™ system (St. Jude Medical Inc., St. Paul, MN, USA). RESULTS Between July 2010 and July 2014, 54 patients (mean age: 13.1 ± 3.7 years) underwent cryoablation using an 8-mm-tip catheter. In 18 of 54 (33%) patients where an 8-mm-tip catheter was the first-choice catheter, the success rate was 18 of 18 (100%). There was a history of previous failed attempts or recurrence with radiofrequency ablation and/or 6-mm-tip cryoablation in 36 of 54 (67%) patients. The success rate in these patients was 24 of 36 (67%). No fluoroscopy was used in 34 of 54 procedures. The recurrence rate was six of 42 (14%) during a mean follow-up period of 32 ± 15 months. In one patient, transient atrioventricular block occurred. CONCLUSIONS Cryoablation with an 8-mm-tip catheter for right-sided APs in children who weigh over 40 kg appears to be safe and acutely effective in cases where conventional ablation methods fail and also as a first choice for ablation procedure. However, the recurrence rate still seems to be high.
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Affiliation(s)
- Ibrahim Cansaran Tanidir
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
| | - Fuheda Dalgic
- Department of Pediatric Cardiology and Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - Neslihan Kiplapinar
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
| | - Hasan Tahsin Tola
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul, Turkey
| | - Celal Akdeniz
- Department of Pediatric Cardiology and Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - Volkan Tuzcu
- Department of Pediatric Cardiology and Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey
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Aksu T, Golcuk SE, Guler TE, Yalin K, Erden I. Prediction of mid-term outcome after cryo-balloon ablation of atrial fibrillation using post-procedure high-sensitivity troponin level. Cardiovasc J Afr 2015; 26:165-70. [PMID: 25783791 PMCID: PMC4683296 DOI: 10.5830/cvja-2015-027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/25/2015] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE High-sensitivity troponin I (hsTnI) assays lead to, among other things, improvement in the detection of myocardial injury and improved risk stratification of patients with atrial fibrillation (AF). The aim of this study was to investigate the association between post-procedure cardiac biomarkers and clinical outcome in patients undergoing cryo-balloon ablation (CA) for AF. METHODS A total of 57 patients (mean age 55.1 ± 12.2 years, 50.9% female) with symptomatic paroxysmal AF underwent the CA procedure. Two hundred and twenty-eight pulmonary veins (PVs) were attempted for pulmonary vein isolation (PVI) with a second-generation cryo-balloon. hsTnI, CK-MB mass and myoglobin samples were prospectively obtained before and 24 hours after ablation. RESULTS At a mean follow up of 214.6 ± 24.3 days, the probability of being arrhythmia free after a single procedure was 86%. Post-ablation hsTnI (p = 0.001), left atrial (LA) diameter (p = 0.002), duration of AF (p = 0.002), mean minimal temperature of the left superior pulmonary vein (p = 0.005), and age (p = 0.021) were associated with increased AF recurrence rate. On multivariate analysis, lower hsTnI level was the only independent predictor for AF recurrence (p = 0.012). Post-ablation hsTnI levels lower than 4.40 ng/ml predicted AF recurrence during follow up, with a sensitivity of 86% and a specificity of 96%. CONCLUSION It is well recognised that the PV antrum contributes to initiation and/or perpetuation of AF. A lower postablation hsTnI level may predict an increased AF recurrence rate, suggesting inadequate ablation of the PV antrum. This may be used as a non-invasive marker to predict the outcome of AF.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Derince Education and Research Hospital, Kocaeli, Turkey.
| | - Sukriye Ebru Golcuk
- Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tümer Erdem Guler
- Department of Cardiology, Derince Education and Research Hospital, Kocaeli, Turkey
| | - Kivanç Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ismail Erden
- Department of Cardiology, Derince Education and Research Hospital, Kocaeli, Turkey
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Ozturk E, Ergul Y, Tanidir IC, Akdeniz C, Tola HT, Tuzcu V. Electroanatomic mapping guided cryoablation of Mahaim pathways in children with limited fluoroscopy exposure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:362-7. [PMID: 25546471 DOI: 10.1111/pace.12559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/01/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The presence of Mahaim accessory pathways (MAP) with anterograde decremental conduction is a disorder that leads to antidromic atrioventricular reentrant tachycardia. There are rare reports of cryoablation use in MAP. This study aims at sharing our experience with using cryoablation to treat MAP in children. METHODS Electrophysiology study and catheter ablation were performed in 14 patients diagnosed with Mahaim tachycardia between January 2010 and December 2013. Cryoablation was used in nine of the cases. A three-dimensional navigation system with surface electrode patches (EnSite System, St. Jude Medical Inc., St. Paul, MN, USA) was used for all procedures. RESULTS The patients (two girls and seven boys) had a median age of 11.5 years (8-18 years) and a median weight of 67 kg (31-80 kg). Mahaim conduction was localized in the right posterolateral (n = 4), right lateral region (n = 2), right posteroseptal (n = 1), right anterolateral (n = 1), and right anterior (n = 1). A pathway potential was noted in six of nine cases at the tricuspid annulus. Catheter choices and acute success rates were as follows: cryoablation in four (three of four successful), radiofrequency catheter ablation (RFA) and cryoablation in five (successful in four of five). No fluoroscopy was used in six of nine patients. The mean procedure duration was 249 ± 90 minutes. No major complications were observed. The final long-term success rate for cryoablation was seven of nine (78%). CONCLUSIONS Cryoablation can be used as a reliable and effective alternative to RFA in the treatment of Mahaim accessory conduction pathways in children. Prospective comparative studies are necessary in order to further evaluate the long-term efficacy of this method.
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Affiliation(s)
- Erkut Ozturk
- Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Istanbul, Turkey
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Houmsse M, Daoud EG. Biophysics and clinical utility of irrigated-tip radiofrequency catheter ablation. Expert Rev Med Devices 2012; 9:59-70. [PMID: 22145841 DOI: 10.1586/erd.11.42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Catheter ablation by radiofrequency (RF) energy has successfully eliminated cardiac tachyarrhythmias. RF ablation lesions are created by thermal energy. Electrode catheters with 4-mm-tips have been adequate to ablate arrhythmias located near the endocardium; however, the 4-mm-tip electrode does not readily ablate deeper tachyarrhythmia substrate. With 8- and 10-mm-tip RF electrodes, ablation lesions were larger; yet, these catheters are associated with increased risk for coagulum, char and thrombus formation, as well as myocardial steam rupture. Cooled-tip catheter technology was designed to cool the electrode tip, prevent excessive temperatures at the electrode tip-tissue interface, and thus allow continued delivery of RF current into the surrounding tissue. This ablation system creates larger and deeper ablation lesions and minimizes steam pops and thrombus formation. The purpose of this article is to review cooled-tip RF ablation biophysics and outcomes of clinical studies as well as to discuss future technological improvements.
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Affiliation(s)
- Mahmoud Houmsse
- Section of Electrophysiology, Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University, Columbus, USA.
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Schmidt M, Marschang H, Clifford S, Harald R, Guido R, Oliver T, Johannes B, Daccarett M. Trends in inflammatory biomarkers during atrial fibrillation ablation across different catheter ablation strategies. Int J Cardiol 2012; 158:33-8. [DOI: 10.1016/j.ijcard.2010.12.084] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 11/13/2010] [Accepted: 12/23/2010] [Indexed: 10/18/2022]
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JAUREGUI-ABULARACH MIGUELE, CAMPOS BIEITO, BETENSKY BRIANP, MICHELE JOHN, GERSTENFELD EDWARDP. Comparison of Epicardial Cryoablation and Irrigated Radiofrequency Ablation in a Swine Infarct Model. J Cardiovasc Electrophysiol 2012; 23:1016-23. [DOI: 10.1111/j.1540-8167.2012.02334.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Manusama R, Timmermans C, van der Schoot M, Philippens S, Rodriguez LM. Comparison of a 6.5, 10, and 15 mm cryoablation catheter-tip for the treatment of common atrial flutter. Europace 2012; 14:1634-8. [DOI: 10.1093/europace/eus091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Schmidt M, Dorwarth U, Straube F, Daccarett M, Rieber J, Wankerl M, Krieg J, Leber AW, Ebersberger U, Huber A, Rummeny E, Hoffmann E. Cryoballoon in AF ablation: impact of PV ovality on AF recurrence. Int J Cardiol 2011; 167:114-20. [PMID: 22206633 DOI: 10.1016/j.ijcard.2011.12.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 11/08/2011] [Accepted: 12/03/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Complete occlusion of the pulmonary veins (PV) is crucial for successful PV isolation. While two different sizes of cryoballoons (23 and 28 mm) are available, complete occlusion is not always achieved in any given PV. We investigated the role of PV ostial anatomy during cryoballoon PV occlusion grading and atrial fibrillation (AF) recurrence rate. METHODS PV ostial diameter was analyzed in 168 consecutive patients (111 men, 61 ± 10 years, 124 paroxysmal (px) and 44 persistent AF) using cardiac computed tomography (CT) prior to procedure. The ovality index at the PV ostial level was calculated in any given PV. During follow-up, 7-day holter monitors were performed at 1, 3, 6, 9, 12, 18 and 24 months post-ablation. RESULTS The success rate at 12 ± 6 months follow-up was 69% including a 3-month blanking period (px AF: 66%; persistent AF 77%). The ovality index of the left-sided PVs was significantly larger ("more oval") than that of the right-sided PVs (p<0.001). An optimized PV occlusion in all individual PVs (complete occlusion, grading 4/4) was achieved during ablation in 49% of patients with AF recurrence and in 73% of patients without AF recurrence (p=0.004). Patients with AF recurrence had "more oval" left-sided PVs compared to patients free from AF recurrence (LSPV 0.40 ± 0.2 vs. 0.33 ± 0.2; p=0.04 and LIPV 0.41 ± 0.3 vs. 0.32 ± 0.2; p=0.03), whereas no significant association was found for right sided PVs. CONCLUSION The ostial PV anatomy seems to have an important impact on clinical outcome and should be considered when planning and performing cryoballoon AF ablation procedures.
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Affiliation(s)
- Martin Schmidt
- Department of Cardiology, Klinikum Bogenhausen, Munich, Germany.
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Wright M, Jaïs P. Radiofrequency ablation: it is not just how hard you push but how you push. J Cardiovasc Electrophysiol 2010; 20:1269-71. [PMID: 20487125 DOI: 10.1111/j.1540-8167.2009.01643.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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WOOD MARKA, GOLDBERG SCOTTM, PARVEZ BABAR, PATHAK VISHESH, HOLLAND KRISTEN, ELLENBOGEN AMYL, HAN FREDERICKT, ALEXANDER DANIEL, LAU MELISSA, RESHKO LEONID, GOEL ANEESH. Effect of Electrode Orientation on Lesion Sizes Produced by Irrigated Radiofrequency Ablation Catheters. J Cardiovasc Electrophysiol 2009; 20:1262-8. [DOI: 10.1111/j.1540-8167.2009.01538.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Atienza F, Almendral J, Sánchez-Quintana D, Zaballos M, Murillo M, Jimeno C, Parra V, Fernández-Avilés F. Cryoablation time-dependent dose-response effect at minimal temperatures (-80 degrees C): an experimental study. Europace 2009; 11:1538-45. [PMID: 19846431 PMCID: PMC2770697 DOI: 10.1093/europace/eup310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To establish a temporal safety window for cryoablation at minimal temperatures and to assess the electrophysiological and histological changes as a function of the application duration. METHODS AND RESULTS Twenty mini-pigs underwent AV nodal cryoablation at -80 degrees C without prior cryomapping. The duration of the cryoapplication following atrioventricular block (AVB) was randomized to 0, 10, 20, 40, or 60 s. Atrioventricular block was obtained in all animals after a median of 3 (1-8 interquartile range) applications. One week later, AV nodal conduction fully recovered in animals with application duration <10 s, whereas persistent AVB incidence increased as a function of time in animals with longer applications duration. Cryoablation application duration following AVB was the only independent predictor of persistent AVB (OR, 1.116; 95% CI, 1.013-1.229; P = 0.026). There was no difference in lesion location or size between animals with vs. those without persistent AVB at 1 week. However, animals randomized to longer application duration demonstrated higher degree of cell destruction and fibrotic content. CONCLUSION In this closed-chest pig model, there was a relation between cryoapplication duration following AVB at -80 degrees C and recovery of conduction. A safety window of at least 10 s was observed in all cases.
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Affiliation(s)
- Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain.
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