Abstract
Background: Atrial fibrillation (AF) may be triggered by premature atrial depolarizations originating in the pulmonary veins (PV). Radiofrequency catheter ablation of PV foci may prevent recurrence of AF, but may cause PV stenosis. Therefore, a safer method for ablation of PV foci is needed. This study evaluated the acute and chronic effects of PV ablation using a cryocatheter ablation (CCA) system, which may be less likely to cause PV stenosis.
Methods: CCA was performed by freezing for 5 minutes or more in one or more PVs in 10 anesthetized dogs. Pacing threshold and vessel diameter were measured before and after PV cryoablation. All dogs were restudied at 4.0 ± 1.64 months (range 2–7) in a manner identical to baseline.
Results: CCA was performed in 27 PVs (range 1–4/dog), with a mean freeze time of 8.62 ± 5.42 minutes per vein (range 5.23–22.06). Mean temperature for all freezes was −65 ± 5.3°C. Mean PV diameter was 6.49 ± 1.73 vs 6.24 ± 1.83 mm (p = NS) and mean pacing threshold 1.32 ± 0.75 vs 9.36 ± 5.93 mA (p < .01), before vs. acutely after ablation. At followup, at the ablation sites PV diameter (7.02 ± 1.88 mm) was unchanged from baseline, whereas pacing threshold remained elevated (2.54 ± 1.44 mA, p < .05 vs baseline). There were no acute or long-term complications.
Conclusions: (1) CCA of PVs produced a significant rise in acute and chronic pacing threshold indicating loss of atrial conductivity. (2) CCA of PVs did not cause PV stenosis or other complications. (3) The data suggest that CCA of PVs may be a safe and effective method for treating focal AF.
Similar content being viewed by others
References
Jais P, Haissaguerre M, Shah DC, Chouairi S, Gencel L, Hocini M, Clementy J. A focal source of atrial fibrillation treated by discrete radiofrequency ablation. Circulation 1997;95:572–576.
Chen SA, Hsieh MH, Tai CT, Tsai CF, Prakash VS, Yu WC, Hsu TL, Ding YA, Chang MS. Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins: Electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation 1999;100:1879–1886.
Lin WS, Prakash VS, Tai CT, Hsieh MH, Tsai CF, Yu WC, Lin YK, Ding YA, Chang MS, Chen SA. Pulmonary vein morphology in patients with paroxysmal atrial fibrillation initiated by ectopic beats originating from the pulmonary veins: Implications for catheter ablation. Circulation. 2000;101:1274–1281.
Kanagaratnam L, Tomassoni G, Schweikert R, Pavia S, Bash D, Beheiry S, Lesh M, Niebauer M, Saliba W, Chung M, Tchou P, Natale A. Empirical pulmonary vein isolation in patients with chronic atrial fibrillation using a threedimensional nonfluoroscopic mapping system: Long-term follow-up. Pacing Clin Electrophysiol 2001;24:1774–1779.
Tse HF, Lee KL, Fan K, Lau CP. Nonfluoroscopic magnetic electroanatomic mapping to facilitate focal pulmonary veins ablation for paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2002;25:57–61.
Pappone C, Rosanio S, Oreto G, Tocchi M, Gugliotta F, Vicedomini G, Salvati A, Dicandia C, Mazzone P, Santinelli V, Gulletta S, Chierchia S. Circumferential radiofrequency ablation of pulmonary vein ostia:Anew anatomic approach for curing atrial fibrillation. Circulation 2000;102:2619–2628.
Tada H, Oral H, Greenstein R, Pelosi F Jr, Knight BP, Strickberger SA, Morady F. Differentiation of atrial and pulmonary vein potentials recorded circumferentially within pulmonary veins. J Cardiovasc Electrophysiol 2002;13:118–123.
Tada H, Oral H, Ozaydin M, Greenstein R, Pelosi F Jr, Knight BP, Strickberger SA, Morady F. Response of pulmonary vein potentials to premature stimulation. J Cardiovasc Electrophysiol 2002;13:33–37.
Tada H, Oral H, Wasmer K, Greenstein R, Pelosi F Jr, Knight BP, Strickberger SA, Morady F. Pulmonary vein isolation: Comparison of bipolar and unipolar electrograms at successful and unsuccessful ostial ablation sites. J Cardiovasc Electrophysiol 2002;13:13–19.
Scanavacca MI, Kajita LJ, Vieira M, Sosa EA. Pulmonary vein stenosis complicating catheter ablation of focal atrial fibrillation. J Cardiovasc Electrophysiol 2000;11:677–681.
Yu WC, Hsu TL, Tai CT, Tsai CF, Hsieh MH, Lin WS, Lin YK, Tsao HM, Ding YA, Chang MS, Chen SA. Acquired pulmonary vein stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2001;12:887–92.
Moak JP, Moore HJ, Lee SW, Giglia TM, Sable CA, Furbush NC, Ringel RR. Case report: Pulmonary vein stenosis following RF ablation of paroxysmal atrial fibrillation: successful treatment with balloon dilation. J Interv Card Electrophysiol 2000;4:621–631.
Wadwha M, Rahme MM, Dobak J, Hong L, Wolf P, Chen P, Feld GK. Transcatheter cryoablation of ventricular myocardium in dogs. J Intervent Cardiac Electrophysiol 2000;4:537–546.
Tsao HM, Wu MH, Yu WC, Tai CT, Lin YK, Hsieh MH, Ding YA, Chang MS, Chen SA. Role of right middle pulmonary vein in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2001;12:1353–1357.
Lustgarten DL, Keane D, Ruskin J. Cryothermal ablation: Mechanism of tissue injury and current experience in the treatment of tachyarrhythmias. Prog Cardiovasc Dis 1999;41:481–498.
Shumway SJ, Johnson EM, Svendsen CA, Kriett JM, Ring WS. Surgical management of ventricular tachycardia. Ann Thorac Surg 1997;63(6):1589–1591.
Natale A, Pisano E, Shewchik J, Bash D, Fanelli R, Potenza D, Santarelli P, Schweikert R, White R, Saliba W, Kanagaratnam L, Tchou P, Lesh M. First human experience with pulmonary vein isolation using a through-the-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation. Circulation 2000;102:1879–1882.
Tanaka K, Satake S, Saito S, Takahashi S, Hiroe Y, Miyashita Y, Tanaka S, Tanaka M, Watanabe Y. A new radiofrequency thermal balloon catheter for pulmonary vein isolation. J Am Coll Cardiol 2001;38:2079–2086.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Feld, G.K., Yao, B., Reu, G. et al. Acute and Chronic Effects of Cryoablation of the Pulmonary Veins in the Dog as a Potential Treatment for Focal Atrial Fibrillation. J Interv Card Electrophysiol 8, 135–140 (2003). https://doi.org/10.1023/A:1023660901347
Issue Date:
DOI: https://doi.org/10.1023/A:1023660901347