BACKGROUND: Thermodynamics in the left atrium-pulmonary vein (PV) junction, phrenic nerve, and esophagus during PV isolation (PVI) using the second-generation cryoballoon are not known. METHODS AND RESULTS: Twenty dogs underwent PVI using second-generation cryoballoon. Ablations were performed for ≤2 deliveries based on PVI without a bonus freeze. Inner balloon, balloon surface, and tissue temperatures were monitored during cryoablation. The tissue thermocouples were placed on the epicardial surface of the left atrium-PV junction, as well as on the phrenic nerve and within the esophagus. A total of 259 cryoballoon and 229 tissue tissue thermocouples profiles during 53 cryoablations of 40 PVs were analyzed. Acutely, PVI was achieved in 36 of 40 PVs (90%). Conductive tissue cooling spread radially from the balloon-left atrium-PV contact point. The lowest tissue temperatures were dependent on the distance of the tissue thermocouples to the balloon surface (r=0.85; P<0.001). In addition, blood flow leaks around the balloon had a warming effect on the balloon and tissue temperature profiles. Chronic isolation (mean, 48±16 days) was achieved in 27 of 36 PVs (75%). In 8 of 9 acutely isolated but with chronic reconnection PVs, the blood flow leak location was concordant with chronic reconnection gap. Although only 1 esophageal ulcerated lesion was observed, neither phrenic nerve palsy nor severe PV stenosis was seen in any dogs. CONCLUSIONS: Variance in tissue thermodynamics during cryothermal ablation depends on the distance from balloon and peri-balloon blood flow leaks. This information may be useful for successful PVI without severe complications.
BACKGROUND: Thermodynamics in the left atrium-pulmonary vein (PV) junction, phrenic nerve, and esophagus during PV isolation (PVI) using the second-generation cryoballoon are not known. METHODS AND RESULTS: Twenty dogs underwent PVI using second-generation cryoballoon. Ablations were performed for ≤2 deliveries based on PVI without a bonus freeze. Inner balloon, balloon surface, and tissue temperatures were monitored during cryoablation. The tissue thermocouples were placed on the epicardial surface of the left atrium-PV junction, as well as on the phrenic nerve and within the esophagus. A total of 259 cryoballoon and 229 tissue tissue thermocouples profiles during 53 cryoablations of 40 PVs were analyzed. Acutely, PVI was achieved in 36 of 40 PVs (90%). Conductive tissue cooling spread radially from the balloon-left atrium-PV contact point. The lowest tissue temperatures were dependent on the distance of the tissue thermocouples to the balloon surface (r=0.85; P<0.001). In addition, blood flow leaks around the balloon had a warming effect on the balloon and tissue temperature profiles. Chronic isolation (mean, 48±16 days) was achieved in 27 of 36 PVs (75%). In 8 of 9 acutely isolated but with chronic reconnection PVs, the blood flow leak location was concordant with chronic reconnection gap. Although only 1 esophageal ulcerated lesion was observed, neither phrenic nerve palsy nor severe PV stenosis was seen in any dogs. CONCLUSIONS: Variance in tissue thermodynamics during cryothermal ablation depends on the distance from balloon and peri-balloon blood flow leaks. This information may be useful for successful PVI without severe complications.
Authors: Arash Aryana; Deep K Pujara; Shelley L Allen; James H Baker; Martin A Espinosa; Eric F Buch; Uma Srivatsa; Ethan Ellis; Kevin Makati; Marcin Kowalski; Sung Lee; Thomas Tadros; Tina Baykaner; Amin Al-Ahmad; André d'Avila; Luigi Di Biase; Kaoru Okishige; Andrea Natale Journal: J Interv Card Electrophysiol Date: 2020-10-03 Impact factor: 1.900
Authors: Henry D Huang; Grzegorz Pietrasik; Qurrat-Ul-Ain Abid; Parikshit S Sharma; Kousik Krishnan; Timothy R Larsen; Richard G Trohman Journal: J Am Heart Assoc Date: 2020-05-12 Impact factor: 5.501