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

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...

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Autores principales: Baust, John M, Robilotto, Anthony, Guerra, Peter, Snyder, Kristi K, Van Buskirk, Robert G, Dubuc, Marc, Baust, John G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946632/
https://www.ncbi.nlm.nih.gov/pubmed/29770216
http://dx.doi.org/10.1177/2050312118769797
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author Baust, John M
Robilotto, Anthony
Guerra, Peter
Snyder, Kristi K
Van Buskirk, Robert G
Dubuc, Marc
Baust, John G
author_facet Baust, John M
Robilotto, Anthony
Guerra, Peter
Snyder, Kristi K
Van Buskirk, Robert G
Dubuc, Marc
Baust, John G
author_sort Baust, John M
collection PubMed
description 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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spelling pubmed-59466322018-05-16 Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias Baust, John M Robilotto, Anthony Guerra, Peter Snyder, Kristi K Van Buskirk, Robert G Dubuc, Marc Baust, John G SAGE Open Med Original Article 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. SAGE Publications 2018-05-04 /pmc/articles/PMC5946632/ /pubmed/29770216 http://dx.doi.org/10.1177/2050312118769797 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by/4.0/ This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Article
Baust, John M
Robilotto, Anthony
Guerra, Peter
Snyder, Kristi K
Van Buskirk, Robert G
Dubuc, Marc
Baust, John G
Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias
title Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias
title_full Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias
title_fullStr Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias
title_full_unstemmed Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias
title_short Assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias
title_sort assessment of a novel cryoablation device for the endovascular treatment of cardiac tachyarrhythmias
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946632/
https://www.ncbi.nlm.nih.gov/pubmed/29770216
http://dx.doi.org/10.1177/2050312118769797
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