Real-time magnetic resonance imaging-guided cryoablation of the pulmonary veins with acute freeze-zone and chronic lesion assessment

Lichter, Justin G.; Kholmovski, Eugene; Coulombe, Nicolas; Ghafoori, Elyar; Kamali, Roya; MacLeod, Rob S.; Ranjan, Ravi

doi:10.1093/europace/euy089

Cited by 21 publications

(18 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For cardiac tissue thicknesses of 0.5 through 3 mm the response interaction was mostly linear (Figures and ); however, at tissue depths of 4 and 5 mm, the additional freeze time to achieve TTI NV was prolonged. Our exponential freeze‐response curve is similar to the real‐time cryoablation measurements recorded using magnetic resonance imaging (MRI) . Specifically, a study by Lichter et al determined by MRI that the normalized area of freeze increased rapidly from the start of cryoablation through 120 seconds, and a further increase in area of freeze was observed at 180 seconds (although the latter had a diminished rate of freeze area increase).…”

Section: Discussionsupporting

confidence: 72%

“…Specifically, a study by Lichter et al determined by MRI that the normalized area of freeze increased rapidly from the start of cryoablation through 120 seconds, and a further increase in area of freeze was observed at 180 seconds (although the latter had a diminished rate of freeze area increase). Last, very little continued growth of the freeze area was observed between 180 and 240 seconds by MRI measurements . This very slow rate of increase beyond the initial 120 seconds explains the very prolonged TTI NV at higher depths.…”

Section: Discussionmentioning

confidence: 99%

“…Last, very little continued growth of the freeze area was observed between 180 and 240 seconds by MRI measurements. 39 This very slow rate of increase beyond the initial 120 seconds explains the very prolonged TTI NV at higher depths.…”

Section: Real-world Usage Of Time-to-isolationmentioning

confidence: 99%

“…Our exponential freeze-response curve is similar to the real-time cryoablation measurements recorded using magnetic resonance imaging (MRI). 39 Specifically, a study by Lichter et al 39 determined by MRI that the normalized area of freeze increased rapidly from the start of cryoablation through 120 seconds, and a further increase in area of freeze was observed at 180 seconds (although the latter had a diminished rate of freeze area increase). Last, very little continued growth of the freeze area was observed between 180 and 240 seconds by MRI measurements.…”

Section: Real-world Usage Of Time-to-isolationmentioning

confidence: 99%

See 3 more Smart Citations

Relationship between time‐to‐isolation and freeze duration: Computational modeling of dosing for Arctic Front Advance and Arctic Front Advance Pro cryoballoons

Getman

Wißner

Ranjan

et al. 2019

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

BackgroundPreclinical and clinical studies have utilized periprocedural parameters to optimize cryoballoon ablation dosing, including acute time‐to‐isolation (TTI) of the pulmonary vein, balloon rate of freezing, balloon nadir temperature, and balloon‐thawing time. This study sought to predict the Arctic Front Advance (AFA) vs Arctic Front Advance Pro (AFA Pro) ablation durations required for transmural pulmonary vein isolation at varied tissue depths.MethodsA cardiac‐specific, three‐dimensional computational model that incorporates structural characteristics, temperature‐dependent cellular responses, and thermal‐conductive properties was designed to predict the propagation of cold isotherms through tissue. The model assumed complete cryoballoon‐to‐pulmonary vein (PV) circumferential contact. Using known temperature thresholds of cardiac cellular electrical dormancy (at 23°C) and cellular nonviability (at −20°C), transmural time‐to‐isolation electrical dormancy (TTIED) and cellular nonviability (TTINV) were simulated.ResultsFor cardiac thickness of 0.5, 1.25, 2.0, 3.0, 4.0, and 5.0 mm, the 23°C isotherm passed transmurally in 33, 38, 46, 62, 80, and 95 seconds during cryoablation utilizing AFA and 33, 38, 46, 63, 80, and 95 seconds with AFA Pro. Using the same cardiac thicknesses, the −20°C isotherm passed transmurally in 40, 55, 78, 161, 354, and 696 seconds during cryoablation with AFA and 40, 54, 78, 160, 352, and 722 seconds with AFA Pro.ConclusionThis model predicted a minimum duration of cryoballoon ablation (TTINV) to obtain a transmural lesion when acute TTI of the PV was observed (TTIED). Consequently, the model is a useful tool for characterizing CBA dosing, which may guide future cryoablation dosing strategies.

show abstract

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Real-world Usage Of Time-to-isolationmentioning

confidence: 99%

Section: Real-world Usage Of Time-to-isolationmentioning

confidence: 99%

See 2 more Smart Citations

Relationship between time‐to‐isolation and freeze duration: Computational modeling of dosing for Arctic Front Advance and Arctic Front Advance Pro cryoballoons

Getman

Wißner

Ranjan

et al. 2019

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

show abstract

“…While 1.5T MRI scanners are the major platform for MRI-guided cardiovascular interventions, a growing amount of attention has been directed to 3T MRI scanners because of the improved signal-to-noise ratio (SNR) and clinical applications in cardiac MRI [18]. Limited evaluation of a glass-fiber epoxy-based guidewire using 3T MRI has been conducted during cryoablation of the pulmonary vein [19]. Further studies are necessary to evaluate the use of glass-fiber epoxy-based guidewires for MRI-guided cardiovascular catheterization at 3T.…”

Section: Introductionmentioning

confidence: 99%

Real-time 3T MRI-guided cardiovascular catheterization in a porcine model using a glass-fiber epoxy-based guidewire

Perotti

Martinez

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

Real-time magnetic resonance imaging (MRI) is a promising alternative to X-ray fluoroscopy for guiding cardiovascular catheterization procedures. Major challenges, however, include the lack of guidewires that are compatible with the MRI environment, not susceptible to radiofrequency-induced heating, and reliably visualized. Preclinical evaluation of new guidewire designs has been conducted at 1.5T. Here we further evaluate the safety (device heating), device visualization, and procedural feasibility of 3T MRI-guided cardiovascular catheterization using a novel MRI-visible glass-fiber epoxy-based guidewire in phantoms and porcine models. Methods To evaluate device safety, guidewire tip heating (GTH) was measured in phantom experiments with different combinations of catheters and guidewires. In vivo cardiovascular catheterization procedures were performed in both healthy (N = 5) and infarcted (N = 5) porcine models under real-time 3T MRI guidance using a glass-fiber epoxy-based guidewire. The times for each procedural step were recorded separately. Guidewire visualization was assessed by measuring the dimensions of the guidewire-induced signal void and contrastto-noise ratio (CNR) between the guidewire tip signal void and the blood signal in real-time gradient-echo MRI (specific absorption rate [SAR] = 0.04 W/kg). Results In the phantom experiments, GTH did not exceed 0.35˚C when using the real-time gradientecho sequence (SAR = 0.04 W/kg), demonstrating the safety of the glass-fiber epoxy-based guidewire at 3T. The catheter was successfully placed in the left ventricle (LV) under real

show abstract

Feasibility test of a sapphire cryoprobe with optical monitoring of tissue freezing

Dolganova

Zotov

Safonova

et al. 2022

Journal of Biophotonics

View full text Add to dashboard Cite

This article describes a sapphire cryoprobe as a promising solution to the significant problem of modern cryosurgery that is the monitoring of tissue freezing. This probe consists of a sapphire rod manufactured by the edge‐defined film‐fed growth technique from Al2O3 melt and optical fibers accommodated inside the rod and connected to the source and the detector. The probe's design enables detection of spatially resolved diffuse reflected intensities of tissue optical response, which are used for the estimation of tissue freezing depth. The current type of the 12.5‐mm diameter sapphire probe cooled down by the liquid nitrogen assumes a superficial cryoablation. The experimental test made by using a gelatin‐intralipid tissue phantom shows the feasibility of such concept, revealing the capabilities of monitoring the freezing depth up to 10 mm by the particular instrumentation realization of the probe. This justifies a potential of sapphire‐based instruments aided by optical diagnosis in modern cryosurgery.

show abstract

Real-time magnetic resonance imaging-guided cryoablation of the pulmonary veins with acute freeze-zone and chronic lesion assessment

Cited by 21 publications

References 20 publications

Relationship between time‐to‐isolation and freeze duration: Computational modeling of dosing for Arctic Front Advance and Arctic Front Advance Pro cryoballoons

Relationship between time‐to‐isolation and freeze duration: Computational modeling of dosing for Arctic Front Advance and Arctic Front Advance Pro cryoballoons

Real-time 3T MRI-guided cardiovascular catheterization in a porcine model using a glass-fiber epoxy-based guidewire

Feasibility test of a sapphire cryoprobe with optical monitoring of tissue freezing

Contact Info

Product

Resources

About