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Europace Advance Access originally published online on October 20, 2009
Europace 2009 11(11):1538-1545; doi:10.1093/europace/eup310
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.
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BASIC RESEARCH

Cryoablation time-dependent dose–response effect at minimal temperatures (–80°C): an experimental study

Felipe Atienza1,*, Jesús Almendral1, Damián Sánchez-Quintana2, Matilde Zaballos3, Margarita Murillo2, Concepción Jimeno3, Verónica Parra3,4 and Francisco Fernández-Avilés1

1 Cardiology Department, Hospital General Universitario Gregorio Marañón, C/ Dr Esquerdo, 46, 28007 Madrid, Spain; 2 Department of Human Anatomy and Cell Biology, Facultad de Medicina de Badajoz, Badajoz, Spain; 3 Anesthesiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; 4 Pathology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

Aims: To establish a temporal safety window for cryoablation at minimal temperatures and to assess the electrophysiological and histological changes as a function of the application duration.

Methods and results: Twenty mini-pigs underwent AV nodal cryoablation at –80°C without prior cryomapping. The duration of the cryoapplication following atrioventricular block (AVB) was randomized to 0, 10, 20, 40, or 60 s. Atrioventricular block was obtained in all animals after a median of 3 (1–8 interquartile range) applications. One week later, AV nodal conduction fully recovered in animals with application duration <10 s, whereas persistent AVB incidence increased as a function of time in animals with longer applications duration. Cryoablation application duration following AVB was the only independent predictor of persistent AVB (OR, 1.116; 95% CI, 1.013–1.229; P = 0.026). There was no difference in lesion location or size between animals with vs. those without persistent AVB at 1 week. However, animals randomized to longer application duration demonstrated higher degree of cell destruction and fibrotic content.

Conclusion: In this closed-chest pig model, there was a relation between cryoapplication duration following AVB at –80°C and recovery of conduction. A safety window of at least 10 s was observed in all cases.

Key Words: Cryothermal ablation, Atrioventricular block, Perinodal ablation, Atrioventricular node, Supraventricular tachycardias

* Corresponding author. Tel: +34 91 586 7020, Fax: +34 91 586 8276, Email: fatienzaf{at}secardiologia.es

Manuscript submitted 8 June 2009. Accepted after revision 13 September 2009.


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