Skip to main content
SpringerLink
Log in

Anatomical pitfalls during encircling cryoablation of the left atrium for atrial fibrillation therapy in the pig

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

We previously published encircling endocardial cryo-isolation of the pulmonary vein (PV) region. This study documented mechanisms of isolation failure using CARTO® mapping. Cryo-isolation used a modified Surgifrost® introduced via a Universal Cardiac Introducer® on the left atrial appendage. Of five pigs, two had incomplete isolation and repeat mapping: Activation was over Bachmann’s bundle (BB) in one and the coronary sinus (CS) in the other. Repeat cryoablation failed to eliminate gaps. Histologically, the BB gap had nonlesioned sub-epicardial fibres and thick fat covering the cryolesioned BB: fat protecting the epicardium from cryoablation. The inferior gap had a large CS, and a thick myocardium bridging the isthmus: myocardial thickness and CS thermal sink preventing transmural cryolesions. CARTO® mapping localized gaps. Although the CS is known to cause failure, its protective mechanism is not well documented. The BB gap is novel. These findings have important clinical implications for isolation of the PV region.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Bauer, A., McDonald, A. D., & Donahue, J. K. (2004). Pathophysiological findings in a model of persistent atrial fibrillation and severe congestive heart failure. Cardiovascular Research, 61, 764–770.

    Article  PubMed  CAS  Google Scholar 

  2. Lin, J. L., Lai, L. P., Lin, C. S., Du, C. C., Wu, T. J., Chen, S. P., et al. (2003). Electrophysiological mapping and histological examinations of the swine atrium with sustained (> or =24 h) atrial fibrillation: A suitable animal model for studying human atrial fibrillation. Cardiology, 99, 78–84.

    Article  PubMed  Google Scholar 

  3. Becker, A. E. (2004). Left atrial isthmus: Anatomic aspects relevant for linear catheter ablation procedures in humans. Journal of Cardiovascular Electrophysiology, 15, 809–812.

    Article  PubMed  Google Scholar 

  4. Lemery, R., Guiraudon, G., & Veinot, J. P. (2003). Anatomic description of Bachmann’s bundle and its relation to the atrial septum. American Journal of Cardiology, 91, 1482–1485.

    Article  PubMed  Google Scholar 

  5. Garrido, M. J., Williams, M., & Argenziano, M. (2004). Minimally invasive surgery for atrial fibrillation: Toward a totally endoscopic, beating heart approach. Journal of Cardiac Surgery, 19, 216–220.

    Article  PubMed  Google Scholar 

  6. Todd, D. M., Skanes, A. C., Guiraudon, G., Guiraudon, C., Krahn, A. D., Yee, R., et al. (2003). Role of the posterior left atrium and pulmonary veins in human lone atrial fibrillation: Electrophysiological and pathological data from patients undergoing atrial fibrillation surgery. Circulation, 108, 3108–3114.

    Article  PubMed  Google Scholar 

  7. Guiraudon, G. M., Jones, D. L., Baindridge, D., & Peters, T. M. (2007). Mitral valve implantation using off-pump closed beating intracardiac surgery: A feasibility study. Interactive Cardiovascular Thoracic Surgery, 6, 603.

    Article  Google Scholar 

  8. Guiraudon, G. M., Jones, D. L., Skanes, A. C., Bainbridge, D., Guiraudon, C. M., Jensen, S., et al. (2005). En bloc exclusion of the pulmonary vein region in the pig using off pump, beating, intra-cardiac surgery: A pilot study of minimally-invasive surgery for atrial fibrillation. Annals of Thoracic Surgery, 80, 1417–1423.

    Article  PubMed  Google Scholar 

  9. Arora, R. C., Waldmann, M., Hopkins, D. A., & Armour, J. A. (2003). Porcine intrinsic cardiac ganglia. Anatomical Record, 271A, 249–258.

    Article  Google Scholar 

  10. Klein, G. J., Guiraudon, G. M., Perkins, D. G., Jones, D. L., Yee, R., & Jarvis, E. (1984). Surgical correction of the Wolff–Parkinson–White syndrome in the closed heart using cryosurgery: A simplified approach. In L. S. Wheatley (Ed.) Cryoanalgesia for horses (pp. 119–125). Wheatley, Ontario: Wheatley Hall.

    Google Scholar 

  11. Guiraudon, G. M., Klein, G. J., Gulamhusein, S., Jones, D. L., Yee, R., Perkins, D. G., et al. (1984). Surgical correction of the Wolff–Parkinson–White syndrome: A new closed-heart technique. Annals of Thoracic Surgery, 37, 67–71.

    Article  PubMed  CAS  Google Scholar 

  12. Jones, D. L., Skanes, A., Guiraudon, G. M., Guiraudon, C. M., & Santioanni, D. (2002). Atrial arrhythmias: Localization and role of cryosurgery. International Journal of Bioelectromagnetism, 2, 119–121.

    Google Scholar 

  13. Skanes, A. C., Jones, D. L., Teefy, P., Guiraudon, C., Yee, R., Krahn, A. D., et al. (2004). Safety and feasibility of cryothermal ablation within the mid- and distal coronary sinus. Journal of Cardiovascular Electrophysiology, 15, 1319–1323.

    Article  PubMed  Google Scholar 

  14. Guiraudon, G. M. (1987). Cryoablation, a versatile tool in arrhythmia surgery. Annals of Thoracic Surgery, 43, 129–130.

    Article  PubMed  CAS  Google Scholar 

  15. Dubuc, M., Talajic, M., Roy, D., Thibault, B., Leung, T. K., & Friedman, P. L. (1998). Feasibility of cardiac cryoablation using a transvenous steerable electrode catheter. Journal of Interventional Cardiac Electrophysiology, 2, 285–92.

    Article  PubMed  CAS  Google Scholar 

  16. Skanes, A. C., Klein, G., Krahn, A., & Yee, R. (2004). Cryoablation: Potentials and pitfalls. Journal of Cardiovascular Electrophysiology, 15, S28–S34.

    Article  PubMed  Google Scholar 

  17. Guiraudon, G. M. (1993). Surgical treatment of atrial fibrillation. Herz, 18, 51–59.

    PubMed  CAS  Google Scholar 

  18. Di, B. L., Fahmy, T. S., Patel, D., Bai, R., Civello, K., Wazni, O. M., et al. (2007). Remote magnetic navigation: Human experience in pulmonary vein ablation. Journal of the American College of Cardiology, 50, 868–874.

    Article  Google Scholar 

  19. Cappato, R., Negroni, S., Pecora, D., Bentivegna, S., Lupo, P. P., Carolei, A., et al. (2003). Prospective assessment of late conduction recurrence across radiofrequency lesions producing electrical disconnection at the pulmonary vein ostium in patients with atrial fibrillation. Circulation, 108, 1599–1604.

    Article  PubMed  Google Scholar 

  20. Defauw, J. J., Guiraudon, G. M., van Hemel, N. M., Vermeulen, F. E., Kingma, J. H., & de Bakker, J. M. (1992). Surgical therapy of paroxysmal atrial fibrillation with the “corridor” operation. Annals of Thoracic Surgery, 53, 564–70.

    Article  PubMed  CAS  Google Scholar 

  21. Todd, D. M., Skanes, A. C., Guiraudon, G. M., Klein, G. J., Krahn, A. D., Yee, R., et al. (2002). The pathology of the left atrium in human lone atrial fibrillation. Circulation, 106, II370.

    Google Scholar 

  22. Guiraudon, G. M., Campbell, C. S., Jones, D. L., McLellan, D. G., & MacDonald, J. (1985). Combined SA and node-AV isolation: A surgical alternative to His bundle ablation in patients with atrial fibrillation. Clinical and Investigative Medicine, 8, 57.

    Google Scholar 

  23. Leitch, J. W., Klein, G., Yee, R., & Guiraudon, G. (1991). Sinus node-atrioventricular node isolation: Long-term results with the “corridor” operation for atrial fibrillation. Journal of the American College of Cardiology, 17, 970–975.

    Article  PubMed  CAS  Google Scholar 

  24. Ott, P., Kirk, M. M., Koo, C., He, D. S., Bhattacharya, B., & Buxton, A. (2007). Coronary sinus and fossa ovalis ablation: Effect on interatrial conduction and atrial fibrillation. Journal of Cardiovascular Electrophysiology, 18, 310–317.

    Article  PubMed  Google Scholar 

  25. van Hemel, N. M., Defauw, J. J., Kingma, J. H., Jaarsma, W., Vermeulen, F. E., de Bakker, J. M., et al. (1994). Long-term results of the corridor operation for atrial fibrillation. British Heart Journal, 71, 170–176.

    Article  PubMed  Google Scholar 

  26. van Hemel, N. M., Defauw, J. J., Guiraudon, G. M., Kelder, J. C., Jessurun, E. R., & Ernst, J. M. (1997). Long-term follow-up of corridor operation for lone atrial fibrillation: Evidence for progression of disease? Journal of Cardiovascular Electrophysiology, 8, 967–973.

    Article  PubMed  Google Scholar 

  27. Cox, J. L. (2004). Surgical treatment of atrial fibrillation: A review. Europace, 5(Suppl 1), S20–S29.

    Article  PubMed  Google Scholar 

  28. Klein, G. J., Guiraudon, G. M., Sharma, A. D., & Jones, D. L. (1985). Controlled cryothermal injury to the AV node: Feasibility for AV nodal modification. PACE [PAB], 8, 630–638.

  29. Klein, G. J., Sealy, W. C., Pritchett, E. L. C., Harrison, L., Hackel, D. B., Davis, D., et al. (1980). Cryosurgical ablation of the atrioventricular node-his bundle: Long-term follow-up and properties of the junctional pace-maker. Circulation, 61, 8–15.

    PubMed  CAS  Google Scholar 

  30. Natale, A., Pisano, E., Shewchik, J., Bash, D., Fanelli, R., Potenza, D., et al. (2000). First human experience with pulmonary vein isolation using a through-the-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation. Circulation, 102, 1879–1882.

    PubMed  CAS  Google Scholar 

  31. Schmidt, B., Chun, K. R., Kuck, K. H., & Antz, M. (2007). Pulmonary vein isolation by high intensity focused ultrasound. Indian Pacing and Electrophysiology Journal, 7, 126–133.

    PubMed  Google Scholar 

  32. Hong, K. N., Russo, M. J., Liberman, E. A., Trzebucki, A., Oz, M. C., Argenziano, M., et al. (2007). Effect of epicardial fat on ablation performance: A three-energy source comparison. Journal of Cardiac Surgery, 22, 1–4.

    Article  Google Scholar 

  33. Armour, J. A., & Hopkins, D. A. (1984). Anatomy of the extrinsic effernet autonomic nerves and ganglia innervating the mammialian heart. In W. C. Randall (Ed.) Nervous control of cardiovascular function (pp. 20–44). New York: Oxford University Press.

    Google Scholar 

  34. Armour, J. A. (2004). Cardiac neuronal hierarchy in health and disease. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, 287, R262–R271.

    PubMed  CAS  Google Scholar 

  35. Sherlag, B. J., Tamanasi, E., Edwards, J., Geng, N. P. S., Lazzra, R., & Jackmann, W. M. (2005). Mapping the onset of atrial fibrillation arising from pulmonary vein and non-pulmonry vein sites in the dog heart. Heart Rhythm, 2, S218.

    Article  Google Scholar 

  36. Sherlag, B. J., Yamanashi, W. S., Patel, U., & Jackman, W. M. (2005). Stimulation of the “sino-atrial” fat pad converts focal pulmonary vein firing into atrial fibrillation in the dog heart. Circulation, 108, IV–85.

    Google Scholar 

  37. Cummings, J. E., Gill, I., Akhrass, R., Dery, M., Biblo, L. A., & Quan, K. J. (2004). Preservation of the anterior fat pad paradoxically decreases the incidence of postoperative atrial fibrillation in humans. Journal of the American College of Cardiology, 43, 994–1000.

    Article  PubMed  Google Scholar 

  38. Nakagawa, H., Sherlag, B. J., Wu, A. W., Lockwood, D., Yokoyama, K., Herring, L., et al. (2005). Addition of selective ablation of autonomic ganglia to pulmonary vein antrum ablation for treatment of paroxysmal and persistent atrial fibrillation. Circulation, 110, III–543.

    Google Scholar 

  39. Po, S. S., Scherlag, B. J., Yamanashi, W. S., Edwards, J., Zhou, J., Wu, R., et al. (2006). Experimental model for paroxysmal atrial fibrillation arising at the pulmonary vein-atrial junctions. Heart Rhythm, 3, 201–208.

    Article  PubMed  Google Scholar 

  40. Jones, D. L., Tuomi, J., Ramsay, D., Guiraudon, C. M., Armour, J. A., Cardinal, R., et al. (2007). Left atrial neuroablation for atrial fibrillation: A feasibility study. Canadian Journal of Cardiology, 23(Suppl. C), 225C.

Download references

Acknowledgement

Supported in part by the Canadian Institutes of Health Research. Surgifrost® cryoprobes were provided by CryoCath Technologies, St. Clair, QC. Carto® catheters were provided by Biosense-Webster, a Johnson & Johnson Company, Diamond Bar, CA.

Author information

Authors and Affiliations

  1. Department of Physiology and Pharmacology, The University of Western Ontario, London, Ontario, Canada, N6A 5C1

    Douglas L. Jones

  2. Department of Medicine, The University of Western Ontario, London, Ontario, Canada

    Douglas L. Jones & Allan C. Skanes

  3. Canadian Surgical Technologies and Advance Robotics, Lawson Health Research Institute, London Health Science Center, London, Ontario, Canada

    Douglas L. Jones, Gerard M. Guiraudon & Allan C. Skanes

  4. Imaging Group, Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada

    Gerard M. Guiraudon

  5. Department of Pathology, The University of Western Ontario, London, Ontario, Canada

    Colette M. Guiraudon

Authors
  1. Douglas L. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gerard M. Guiraudon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Allan C. Skanes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Colette M. Guiraudon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas L. Jones.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jones, D.L., Guiraudon, G.M., Skanes, A.C. et al. Anatomical pitfalls during encircling cryoablation of the left atrium for atrial fibrillation therapy in the pig. J Interv Card Electrophysiol 21, 187–193 (2008). https://doi.org/10.1007/s10840-008-9205-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-008-9205-6

Keywords

Search

Navigation