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Bourier F, Takigawa M, Lam A, Vlachos K, Ramirez FD, Martin CA, Frontera A, Kitamura T, Duchateau J, Pambrun T, Derval N, Denis A, Cox J, Cabrita D, Babkin A, Constantin M, Jais P, Sacher F, Dubois R, Bernus O, Haissaguerre M, Hocini M. Ultralow temperature cryoablation: Safety and efficacy of preclinical atrial and ventricular lesions. J Cardiovasc Electrophysiol 2021; 32:570-577. [PMID: 33476463 DOI: 10.1111/jce.14907] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/23/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ultralow temperature cyroablation (ULTC) is designed to create focal, linear, and circumferential lesions. The aim of this study was to assess the safety, efficacy, and durability of atrial and ventricular ULTC lesions in preclinical large animal models. METHODS AND RESULTS The ULTC system uses nitrogen near its liquid-vapor critical point to cool 11-cm ablation catheters. The catheter can be shaped to specific anatomies using pre-shaped stylets. ULTC was used in 11 swine and four sheep to create atrial (pulmonary vein isolation and linear ablation) and ventricular lesions. Acute and 90-day success were evaluated by intracardiac mapping and histologic examination. Cryoadherence was observed during all ULTC applications, ensuring catheter stability at target locations. Local electrograms were completely eliminated immediately after the first single-shot ULTC application in 49 of 53 (92.5%) atrial and in 31 of 32 (96.9%) ventricular applications. Lesion depth as measured on histology preparations was 1.96 ± 0.8 mm in atrial and 5.61 ± 2.2 mm in ventricular lesions. In all animals, voltage maps and histology demonstrated transmural and durable lesions without gaps, surrounded by intact collagen fibers without injury to surrounding tissues. Transient coronary spasm could be provoked with endocardial ULTC in the left ventricle in close proximity to a coronary artery. CONCLUSIONS ULTC created effective and efficient atrial and ventricular lesions in vivo without procedural complications in two large animal models. ULTC lesions were transmural, contiguous, and durable over 3 months.
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Affiliation(s)
- Felix Bourier
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Masateru Takigawa
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Anna Lam
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Konstantinos Vlachos
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - F Daniel Ramirez
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Claire A Martin
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Antonio Frontera
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Takeshi Kitamura
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Nicolas Derval
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Jerry Cox
- ADAGIO Medical, Laguna Hills, California, USA
| | | | | | - Marion Constantin
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jais
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Rémi Dubois
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Oliver Bernus
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Michel Haissaguerre
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.,Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France
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Basu-Ray I, Khanra D, Shah SK, Mukherjee A, Char SV, Jain B, Bunch TJ, Gold M, Adeboye AA, Saeed M. Meta-analysis comparing outcomes of catheter ablation for ventricular arrhythmia in ischemic versus nonischemic cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:54-62. [PMID: 33216394 PMCID: PMC7984079 DOI: 10.1111/pace.14129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/20/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022]
Abstract
Background Catheter ablation is an effective treatment for ventricular arrhythmia (VA) in ischemic cardiomyopathy (ICM). However, results in non‐ICM (NICM) patients are not satisfactory, and studies comparing differences between NICM and ICM are limited. We conducted a meta‐analysis of procedural characteristics and long‐term outcomes of catheter ablation for VA, comparing results between ICM and NICM. Methods Studies in the PubMed, EMBASE, and Cochrane databases were systematically reviewed. Four studies reporting comparison of catheter ablation of VA between ICM and NICM were examined. The Newcastle‐Ottawa Scale was used to appraise study quality. A random‐effects model with inverse variance method was used for comparisons. Results Epicardial approach was significantly more undertaken for the NICM group than in the ICM group (odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.09‐0.18; P < .00001). Mean ablation time (P = .54), fluoroscopy time (P = .55), and procedural time (P = .18) did not differ significantly between the ICM and NICM groups. Procedural failure rates (OR: 0.46; 95% CI: 0.24‐0.89; P = .02) and VA recurrence rates (risk ratio [RR]: 0.68; 95% CI: 0.46‐1.01; P = .06) were significantly higher in the NICM group than in the ICM group. However, all‐cause mortality (RR: 1.37; 95% CI: 0.75‐2.49; P = .31) did not differ significantly between groups. Conclusions Procedural failure and VA recurrence rates were significantly higher in the NICM group, despite significantly more frequent epicardial access. These highlight the limitations of catheter ablation for VA in NICM, given our current knowledge.
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Affiliation(s)
- Indranill Basu-Ray
- Department of Cardiology, Memphis VA Medical Center, 1030 Jefferson Ave, Memphis, TN, 38104.,School of Public Health, The University of Memphis, Memphis, TN, USA.,Dept of Cardiology, All India Institute of Medical Sciences, Rishikesh, UK, India
| | - Dibbendhu Khanra
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Sumit K Shah
- Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Sudhanva V Char
- Department of Cardiology, Life University, Marietta, Georgia
| | - Bhavna Jain
- Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - T Jared Bunch
- Department of Cardiology, University of Utah Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | - Michael Gold
- Department of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Adedayo A Adeboye
- Department of Cardiology, Memphis VA Medical Center, 1030 Jefferson Ave, Memphis, TN, 38104
| | - Mohammad Saeed
- Department of Cardiology, Medical University of South Carolina, Charleston, South Carolina.,Department of Cardiology, Baylor College of Medicine, Houston, Texas
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