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Atrial linear lesions: feasibility using cryoablation.

Klaus Kettering1, Rasool Al-Ghobainy, Manfred Wehrmann

  • 1Department of Cardiology, University of Tuebingen, Tuebingen, Germany. klaus.kettering@t-online.de

Pacing and Clinical Electrophysiology : PACE
|April 12, 2006
PubMed
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Cryoablation can create linear lesions in the atrium safely, offering an alternative to radiofrequency ablation. However, achieving complete conduction block remains a challenge with current cryoablation technology.

Area of Science:

  • Electrophysiology
  • Cardiovascular interventions
  • Minimally invasive cardiac surgery

Background:

  • Atrial fibrillation (AF) treatment involves creating linear lesions in the left atrium to modify its electrical substrate.
  • Radiofrequency (RF) ablation for these lesions is time-consuming, technically challenging, and carries risks.
  • Cryoablation presents a potential alternative to overcome RF ablation's limitations.

Purpose of the Study:

  • To evaluate the feasibility and safety of creating long linear lesions using cryotherapy in the atrium.
  • To compare the characteristics of cryoablation lesions with those produced by RF ablation.

Main Methods:

  • Linear lesions were created in the right atrial septum of six pigs using a 7-F Freezor cryocatheter.
  • Cryoapplications were maintained at -75°C for 4 minutes.

Related Experiment Videos

  • Lesion evaluation involved nonfluoroscopic navigation (LocaLisa), CARTO system mapping, and postmortem examination.

    • Main Results:

    • Successful creation of right atrial septal linear lesions in all pigs, requiring a median of 16 cryoapplications.
    • Significant decrease in intracardiac electrogram amplitudes post-ablation.
    • CARTO mapping showed low potentials and sharply demarcated lesions, but incomplete conduction block in all cases, often with a gap near the fossa ovalis.
    • Postmortem examination confirmed sharply demarcated lesions without ulcerations; no major complications occurred.

    Conclusions:

    • Cryoablation is a feasible and safe method for creating long linear lesions in the atrium.
    • Lesion characteristics differ from RF ablation and appear more favorable.
    • Achieving a transmural lesion and complete conduction block remains an unresolved challenge with current cryoablation techniques.
    • Future technical improvements and increased experience may address current limitations.