Spatial and Time-Course Thermodynamics During Pulmonary Vein Isolation Using the Second-Generation Cryoballoon in a Canine In Vivo Model

Takami, Mitsuru; Misiri, Juna; Lehmann, H. Immo; Parker, Kay; Johnson, Susan B.; Sarmiento, Ray I.; Packer, Douglas L.

doi:10.1161/circep.114.002137

Cited by 43 publications

(42 citation statements)

References 13 publications

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“…Conductive cooling delay in PN and internal esophagus was observed in both 3-and 4-minute ablations. Previously, we showed the spread of conductive cooling for each direction from the balloon-tissue contact point, 9 explaining latent cooling that was seen in PN or esophagus even after termination of cryoablation. No severe PN or esophageal complications were observed in this study.…”

Section: Ablation Durationmentioning

confidence: 88%

Section: Tissue Temperature Monitoringmentioning

confidence: 99%

“…9 After transseptal puncture, a 12 F deflectable sheath (FlexCath; Medtronic CryoCath LP) was introduced. A 3.3 F 15-mm circular catheter (Achieve mapping catheter; Medtronic) was used through the central lumen of a 10.5 F 28-/23-mm cryoballoon catheter (Arctic Front Advance; Medtronic CryoCath LP).…”

Section: Cryoballoon Ablationmentioning

confidence: 99%

“…8,9 Distances were calculated from digitally acquired right and left anterior oblique views with the 15 F sheath and balloon diameters serving for calibration.…”

Section: Distance Analysismentioning

confidence: 99%

“…We reported that blood flow leaks around the balloon cause a warming effect on balloon and tissue temperatures. 9 Higher complete vein occlusion rates with use of 23-mm cryoballoon may explain lower balloon and tissue temperatures. However, we observed a trend toward longer balloon thawing time in 28-mm cryoballoon than in 23-mm cryoballoon.…”

Section: Different Thermodynamics Between 23-and 28-mm Cryoballoonsmentioning

confidence: 99%

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Impact of Freezing Time and Balloon Size on the Thermodynamics and Isolation Efficacy During Pulmonary Vein Isolation Using the Second Generation Cryoballoon

Takami

Lehmann

Misiri

et al. 2015

Circ: Arrhythmia and Electrophysiology

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BackgroundRecently, pulmonary vein isolation (PVI) using the second generation cryoballoon, introduced as a therapy for patients with drug-refractory atrial fibrillation, has shown better outcomes than with the first generation cryoballoon. [1][2][3][4][5] However, some questions about the second generation cryoballoon remain. Several studies in cryobiology have shown that prolongation of freeze duration produces a greater destructive effect in noncardiac tissue. 6,7 However, ablation duration to achieve acute and long-term PVI is still debatable. It is also unclear how different sized balloons (23 and 28 mm) should be used, as the impact of the balloon size on tissue and balloon temperature profiles and ablative lesion size have not been studied. Information on the effects of ablation duration and balloon size is required to achieve high PVI success rates without severe complications using the second generation cryoballoon.The purpose of this study was to investigate the impact of ablation duration and balloon size on tissue and balloon thermodynamics, acute and chronic PVI success rates, complications, and chronic histological changes of the PV and left atrium (LA). Methods GeneralThis study was designed to compare the ablation effect and safety of different ablation durations (3 versus 4 minutes) and different balloon sizes (23 versus 28 mm) in an in vivo model. Twenty-six dogs underwent PVI using second generation cryoballoon. Animal PreparationThe protocol was approved by Mayo Foundation Institutional Animal Care and Use Committee. Dogs (30.3±2.5 kg) were anesthetized with intravenous ketamine and diazepam, intubated, and maintained on 1% to 3% isoflurane. The surface ECG, body temperature, and blood pressure were monitored. Tissue Temperature MonitoringTissue temperatures were monitored by implanted thermocouples, as reported previously. 8,9 All dogs underwent left/right thoracotomy for access to the superior/inferior PVs. The pericardium was opened to © 2015 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-The differences in ablation characteristics of freezing time and balloon size using second generation cryoballoon are still unknown. Methods and Results-Twenty-six dogs underwent pulmonary vein (PV) isolation. Balloon and tissue temperatures (left atrial-PV junction, phrenic nerve, and internal esophagus) were monitored. The ablation duration was randomized to either 3 or 4 minutes, which did not show significant differences in temperature profiles, PV isolation success rate, complications, or histological changes. Twenty dogs underwent cryoablation using 28-mm cryoballoon, 6 dogs were done using the 23-mm cryoballoon. Positioning of the 23-mm cryoballoon was more distal in the PV, which resulted in better PV occlusion. Temperature profiles showed lower temperatures in the 23-mm cryoballoon than in the 28-mm cryoballoon

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Section: Ablation Durationmentioning

confidence: 88%

Section: Tissue Temperature Monitoringmentioning

confidence: 99%

Section: Cryoballoon Ablationmentioning

confidence: 99%

“…8,9 Distances were calculated from digitally acquired right and left anterior oblique views with the 15 F sheath and balloon diameters serving for calibration.…”

Section: Distance Analysismentioning

confidence: 99%

Section: Different Thermodynamics Between 23-and 28-mm Cryoballoonsmentioning

confidence: 99%

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Impact of Freezing Time and Balloon Size on the Thermodynamics and Isolation Efficacy During Pulmonary Vein Isolation Using the Second Generation Cryoballoon

Takami

Lehmann

Misiri

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Dosing of the second-generation cryoballoon using acute time-to-pulmonary vein isolation as an indicator of durable ablation in a canine model

Coulombe

Kirchhof

et al. 2018

J Interv Card Electrophysiol

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In a canine model, effective PV isolation could be found even in the shortest duration dosing cohort (TTE + 60 s). One complication (phrenic nerve injury) was observed in the longest duration dosing group (2 × 180 s). Further studies will be required to correlate these results to a 28-mm cryoballoon (more commonly used in the cryoablation of a human LA); however, to date, this is the first reporting of a successful cryoablation using TTE + 60 s dosing (approximately 90 s total duration of freezing).

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Left atrial posterior wall isolation in conjunction with pulmonary vein isolation using cryoballoon for treatment of persistent atrial fibrillation (PIVoTAL): study rationale and design

Aryana

Pujara²,

Allen

et al. 2020

J Interv Card Electrophysiol

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Spatial and Time-Course Thermodynamics During Pulmonary Vein Isolation Using the Second-Generation Cryoballoon in a Canine In Vivo Model

Abstract: 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.

Cited by 43 publications

References 13 publications

Impact of Freezing Time and Balloon Size on the Thermodynamics and Isolation Efficacy During Pulmonary Vein Isolation Using the Second Generation Cryoballoon

Impact of Freezing Time and Balloon Size on the Thermodynamics and Isolation Efficacy During Pulmonary Vein Isolation Using the Second Generation Cryoballoon

Dosing of the second-generation cryoballoon using acute time-to-pulmonary vein isolation as an indicator of durable ablation in a canine model

Left atrial posterior wall isolation in conjunction with pulmonary vein isolation using cryoballoon for treatment of persistent atrial fibrillation (PIVoTAL): study rationale and design

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