Endocardial hypothermia and pulmonary vein isolation with epicardial cryoablation in a porcine beating-heart model

Masroor, Saqib; Jahnke, Mary-Ellen; Carlisle, Antoine D.; Cartier, Catherine; Lalonde, Jean‐Pierre; MacNeil, Timothy; Tremblay, André; Clubb, Fred J.

doi:10.1016/j.jtcvs.2007.12.038

Cited by 20 publications

(9 citation statements)

References 22 publications

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“…Masroor et al . were able to produce transmural right ventricular lesions during epicardial freezing in pigs [125]. Kettering et al produced long linear lesions with a cryocatheter in pigs by using multiple points of application at −75°C for four minutes [104].…”

Section: Diverse Tissuementioning

confidence: 99%

Experimental cryosurgery investigations in vivo

2009

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Cryosurgery is the use of freezing temperatures to elicit an ablative response in a targeted tissue. This review provides a global overview of experimentation in vivo which has been the basis of advancement of this widely applied therapeutic option. The cellular and tissue-related events that underlie the mechanisms of destruction, including direct cell injury (cryolysis), vascular stasis, apoptosis and necrosis, are described and are related to the optimal methods of technique of freezing to achieve efficacious therapy. In vivo experiments with major organs, including wound healing, the putative immunological response following thawing, and the use of cryoadjunctive strategies to enhance cancer cell sensitivity to freezing, are described.

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Section: Diverse Tissuementioning

confidence: 99%

Experimental cryosurgery investigations in vivo

2009

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“…4 , 13 – 18 As the use of cryotherapy continues to grow, improvements to device design and application will further increase its utilization for the treatment of cardiac arrhythmias. 4 – 12 , 19 , 20 …”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] A plethora of studies have detailed the use of various cryosurgical devices and procedures to apply freezing temperatures to a target tissue. [4][5][6][7][8][9][10][11][12] With the recent reports on the success of cryo for atrial fibrillation (AF) treatment, there is now increasing use of cryo as a standalone, minimally invasive procedure to treat many forms of cardiac arrhythmias. 4,[13][14][15][16][17][18] As the use of cryotherapy continues to grow, improvements to device design and application will further increase its utilization for the treatment of cardiac arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias

et al. 2018

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Objectives:Cryoablation is an effective alternative treatment for cardiac arrhythmias offering shortened recovery and reduced side effects. As the use of cryoablation increases, the need for new devices and procedures has emerged. This has been driven by technological limitations including lengthy periods to generate a single lesion (3–5 min), uncertain transmurality, and differential efficacy. Furthermore, due to limited ablation capacity under high heat loads, cryo has had limited success in the treatment of ventricular arrhythmias. To this end, in this study we evaluated a new cryoablation catheter, ICEolate, for the targeted ablation of cardiac tissue.Methods:Performance assessment included calorimetry, freeze zone isothermal distribution characterization and catheter ablation capacity in a submerged, circulating, heat-loaded ex vivo tissue model. A pilot in vivo study was also conducted to assess ablative capacity of the cryocatheter in a fully beating heart.Results:Ex vivo studies demonstrated ice formation at the tip of a cryocatheter within 5 s and a tip temperature of ~−150°C within 10 s. The device repeatedly generated freeze zones of 2 cm × 3 cm in less than 2 min. Tissue model studies revealed the generation of a full thickness (5–10 mm) cryogenic lesion within 1 min with an opposite (transmural) surface temperature of <−60°C under a circulating 37°C heat load. Pilot in vivo studies demonstrated the delivery of an ablative “dose,” producing a continuous full thickness transmural linear lesion in <60 s at both atrial and ventricular sites.Conclusion:These studies suggest that the supercritical nitrogen cryodevice and ICEolate cryocatheter may provide for rapid, effective, controllable freezing of targeted tissue. The ablative power, speed, and directional freeze characteristics also offer the potential of improved safety via a reduction in procedural time compared to current cryoablation devices. These technological developments may open new avenues for the application of cryo to treat other cardiac arrhythmogenic disorders.

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“…Wadhwa et al reported that successful transmurality was achieved with catheter cryoablation in the canine ventricle [38]. Masroor et al reported that endocardial hypothermia was achieved with epicardial cryoablation on a beating heart model in pigs [39]. Schill et al reported that the latest cryoablation probe produced transmural lesions in 97% of the arrested heart in an ovine model [40].…”

Section: Transmurality Of Cryoablationmentioning

confidence: 99%

Histopathological Change Following Cox-Maze IV Procedure for Atrial Fibrillation

Murashita¹

2018

Cardiac Arrhythmias

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The prevalence of atrial fibrillation and the likelihood of undergoing concomitant surgical ablation at the time of open heart surgery are increasing. Currently, the conventional cutand-sew Maze procedure has been predominantly replaced by Cox-Maze IV procedure, in which new energy sources such as radiofrequency energy and/or cryoablation are applied. Cox-Maze IV procedure has been associated with lower rate of complications than a cutand-sew procedure. However, some previous studies reported the lower success rate of Cox-Maze IV procedure, possibly because radiofrequency ablation or cryoablation cannot always achieve transmurality. For the success of surgical ablation, achieving transmurality, defined as complete atrial wall thickness of fibrotic changes, is of paramount importance. A review of previous articles regarding histopathological changes of the atrial tissue following surgical ablation is performed. The effectiveness of new energy sources such as radiofrequency and cryoablation in terms of histological transmurality is discussed.

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Endocardial hypothermia and pulmonary vein isolation with epicardial cryoablation in a porcine beating-heart model

Cited by 20 publications

References 22 publications

Experimental cryosurgery investigations in vivo

Experimental cryosurgery investigations in vivo

Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias

Histopathological Change Following Cox-Maze IV Procedure for Atrial Fibrillation

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