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

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

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background - 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 (inner balloon, median [range]: -51.5 [-66.0 to -31.0] versus -43.0 [-64.0 to -26.0]°C, P<0.001; balloon surface: -43.0 [-60.0 to -15.8] versus -6.5 [-46.2 to 28.9]°C, P<0.001; left atrial-PV junction: -6.7 [-20.0 to 21.4] versus 15.8 [-14.4 to 35.1]°C, P<0.001), and trended toward a higher PV isolation success rate in the 23-mm cryoballoon. Histologically, deeper extensions of ablative lesions into the PV were seen with 23-mm cryoballoon, and larger ablative lesions were seen in the left atrial antrum using 28-mm cryoballoon. Conclusions - The efficacy of 3-minute ablation was not significantly different from 4-minute ablation in dogs. The 23-mm cryoballoon had a greater cooling effect than the 28-mm cryoballoon for small PVs, but showed narrower ablative lesions in the left atrial antrum.

Original languageEnglish (US)
Pages (from-to)836-845
Number of pages10
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number4
DOIs
StatePublished - Aug 22 2015

Fingerprint

Pulmonary Veins
Thermodynamics
Freezing
Dogs
Temperature
Phrenic Nerve
Cryosurgery
Esophagus

Keywords

  • atrial fibrillation
  • cryoballoon
  • esophagus
  • freezing
  • pulmonary vein
  • thermodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Impact of Freezing Time and Balloon Size on the Thermodynamics and Isolation Efficacy during Pulmonary Vein Isolation Using the Second Generation Cryoballoon. / Takami, Mitsuru; Lehmann, H. Immo; Misiri, Juna; Parker, Kay D.; Sarmiento, Ray I.; Johnson, Susan B.; Packer, Douglas L.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 8, No. 4, 22.08.2015, p. 836-845.

Research output: Contribution to journalArticle

Takami, Mitsuru ; Lehmann, H. Immo ; Misiri, Juna ; Parker, Kay D. ; Sarmiento, Ray I. ; Johnson, Susan B. ; Packer, Douglas L. / Impact of Freezing Time and Balloon Size on the Thermodynamics and Isolation Efficacy during Pulmonary Vein Isolation Using the Second Generation Cryoballoon. In: Circulation: Arrhythmia and Electrophysiology. 2015 ; Vol. 8, No. 4. pp. 836-845.
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abstract = "Background - 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 (inner balloon, median [range]: -51.5 [-66.0 to -31.0] versus -43.0 [-64.0 to -26.0]°C, P<0.001; balloon surface: -43.0 [-60.0 to -15.8] versus -6.5 [-46.2 to 28.9]°C, P<0.001; left atrial-PV junction: -6.7 [-20.0 to 21.4] versus 15.8 [-14.4 to 35.1]°C, P<0.001), and trended toward a higher PV isolation success rate in the 23-mm cryoballoon. Histologically, deeper extensions of ablative lesions into the PV were seen with 23-mm cryoballoon, and larger ablative lesions were seen in the left atrial antrum using 28-mm cryoballoon. Conclusions - The efficacy of 3-minute ablation was not significantly different from 4-minute ablation in dogs. The 23-mm cryoballoon had a greater cooling effect than the 28-mm cryoballoon for small PVs, but showed narrower ablative lesions in the left atrial antrum.",
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T1 - Impact of Freezing Time and Balloon Size on the Thermodynamics and Isolation Efficacy during Pulmonary Vein Isolation Using the Second Generation Cryoballoon

AU - Takami, Mitsuru

AU - Lehmann, H. Immo

AU - Misiri, Juna

AU - Parker, Kay D.

AU - Sarmiento, Ray I.

AU - Johnson, Susan B.

AU - Packer, Douglas L

PY - 2015/8/22

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N2 - Background - 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 (inner balloon, median [range]: -51.5 [-66.0 to -31.0] versus -43.0 [-64.0 to -26.0]°C, P<0.001; balloon surface: -43.0 [-60.0 to -15.8] versus -6.5 [-46.2 to 28.9]°C, P<0.001; left atrial-PV junction: -6.7 [-20.0 to 21.4] versus 15.8 [-14.4 to 35.1]°C, P<0.001), and trended toward a higher PV isolation success rate in the 23-mm cryoballoon. Histologically, deeper extensions of ablative lesions into the PV were seen with 23-mm cryoballoon, and larger ablative lesions were seen in the left atrial antrum using 28-mm cryoballoon. Conclusions - The efficacy of 3-minute ablation was not significantly different from 4-minute ablation in dogs. The 23-mm cryoballoon had a greater cooling effect than the 28-mm cryoballoon for small PVs, but showed narrower ablative lesions in the left atrial antrum.

AB - Background - 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 (inner balloon, median [range]: -51.5 [-66.0 to -31.0] versus -43.0 [-64.0 to -26.0]°C, P<0.001; balloon surface: -43.0 [-60.0 to -15.8] versus -6.5 [-46.2 to 28.9]°C, P<0.001; left atrial-PV junction: -6.7 [-20.0 to 21.4] versus 15.8 [-14.4 to 35.1]°C, P<0.001), and trended toward a higher PV isolation success rate in the 23-mm cryoballoon. Histologically, deeper extensions of ablative lesions into the PV were seen with 23-mm cryoballoon, and larger ablative lesions were seen in the left atrial antrum using 28-mm cryoballoon. Conclusions - The efficacy of 3-minute ablation was not significantly different from 4-minute ablation in dogs. The 23-mm cryoballoon had a greater cooling effect than the 28-mm cryoballoon for small PVs, but showed narrower ablative lesions in the left atrial antrum.

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KW - pulmonary vein

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