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Parameters associated with acute morphometric lesion dimensions created by cryocatheters

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Despite the wide use of cryoenergy, there is a paucity of data regarding the impact of certain ablation parameters on lesion size. Specifically, this study sought to evaluate the impact of catheter type, ablation time, heat load, and tip orientation on lesion dimensions using a porcine thigh model with focal cryoablation catheters.

Methods

In 6 pigs, 251 lesions were created on thigh muscle with parameter permutations to compare the acute impact of catheter type (electrode tip sizes 4, 6, and 8 mm), ablation time (2, 2 × 2, 3, 4, and 2 × 4 min), heat load (1 and 2 L/min), and tip orientation (perpendicular or parallel) on lesion dimensions (length, depth, and cross-sectional area) immediately post-ablation. As a sub-study to evaluate the importance of tissue contact during the cryoablation procedure, a 1-min freeze was performed without tissue contact until an ice ball formed, followed by an additional 2–3 min freeze.

Results

The linear regression model revealed that catheter type (p < 0.0001) and the interaction between catheter orientation and catheter type (p = 0.027) were significantly associated with lesion cross-sectional area. Lesion length and depth, but not cross-sectional area, are significantly impacted by the catheter type (p < 0.0001; p = 0.003) and orientation (p < 0.0001; p < 0.0001), respectively. Compared to parallel catheter placement, lesions created with the perpendicular orientation were deeper using 4-mm (p = 0.136), 6-mm (p = 0.005), and 8-mm tip catheter (p = 0.004). Lesion creation with an ice ball significantly reduced lesion depth compared to lesions made without an ice ball (p < 0.05). In contrast, ablation time (p = 0.097) and heat load (p = 0.467) were not significantly associated with lesion size. Additionally, there was no statistical significant difference in lesion size between 2 × 2 and 4 min ablation times.

Conclusions

The present study demonstrated that lesion size was significantly impacted by catheter type and catheter tip orientation and that maintaining tissue contact prior to applying cryoenergy is essential.

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Abbreviations

TTC:

2,3,5-Triphenyltetrazolium chloride

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Funding

This work was financially supported through a Medtronic research grant.

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Authors and Affiliations

  1. Cardiology Division, Cardiovascular Center, Tsuchiura Kyodo Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan

    Shinsuke Miyazaki

  2. Medtronic, Inc., Minneapolis, MN, USA

    Heather O’Connell

  3. Medtronic Bakken Research Center, Maastricht, The Netherlands

    Baerbel Maus

Authors
  1. Shinsuke Miyazaki
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  2. Heather O’Connell
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  3. Baerbel Maus
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Corresponding author

Correspondence to Shinsuke Miyazaki.

Ethics declarations

The pig specimens were housed and received humane care in accordance with the Guide for Care and Use of Laboratory Animals and the Animal Welfare Act as amended. The study protocol was reviewed and approved by the Medtronic PRL IACUC (Institutional Animal Care and Use Committee).

Conflict of interest

The authors declare that they have no conflict of interest.

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Miyazaki, S., O’Connell, H. & Maus, B. Parameters associated with acute morphometric lesion dimensions created by cryocatheters. J Interv Card Electrophysiol 54, 109–118 (2019). https://doi.org/10.1007/s10840-018-0452-x

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  • DOI: https://doi.org/10.1007/s10840-018-0452-x

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