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Evaluation of the direction and extent of ice formation during cryoballoon ablation: an experimental study

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The distal hemisphere of a balloon is generally cooled during cryoapplication. However, a wide ablation area can be acquired after cryoballoon ablation. This study aimed to evaluate the extent of ice formation on two types of balloon surfaces through experimental and simulation studies.

Methods

A standard cryoballoon (SCB; Arctic Front Advance Pro, Medtronic) and novel cryoballoon (NCB; POLARx, Boston Scientific) were frozen for 240 s in 36 °C normal saline solution to observe ice formation on the balloon surface. Pieces of porcine tissue were placed between the upper and lower sides of the balloon, and the balloon was frozen in the horizontal direction for 240 s in 20 attempts (10 for SCB and NCB each). The measured areas of ice formation were evaluated and compared between the upper and lower sides of each balloon.

Results

Ice formation was greater on the lower side of the balloon than on the upper side. A larger area of ice formation in the tissue slab was observed on the lower side than on the upper side in both balloons, and the ice formation extended to the proximal hemisphere on the lower side of the balloon. The ice formation area in the NCB was significantly larger than that in SCB.

Conclusions

Ice formation was significantly greater on the lower side of the cryoballoon than on the upper side and extended to the proximal hemisphere of the balloon, which might facilitate the acquisition of a wide ablation area on the left atrial posterior wall after cryoballoon ablation.

Graphical Abstract

Different ice formation after cryoballoon ablation

Greater ice formation on the lower side of cryoballoon and an extensive ice formation in the proximal hemisphere, especially in novel cryoballoon.

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References

  1. Kuck KH, Brugada J, Furnkranz A, Metzner A, Ouyang F, Chun KR, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374(23):2235–45. https://doi.org/10.1056/NEJMoa1602014.

    Article  PubMed  Google Scholar 

  2. Kuck KH, Furnkranz A, Chun KR, Metzner A, Ouyang F, Schluter M, et al. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial. Eur Heart J. 2016;37(38):2858–65. https://doi.org/10.1093/eurheartj/ehw285.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Assaf A, Bhagwandien R, Szili-Torok T, Yap SC. Comparison of procedural efficacy, balloon nadir temperature, and incidence of phrenic nerve palsy between two cryoballoon technologies for pulmonary vein isolation: a systematic review and meta-analysis. J Cardiovasc Electrophysiol. 2021;32(9):2424–31. https://doi.org/10.1111/jce.15182.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Knecht S, Sticherling C, Roten L, Badertscher P, Chollet L, Küffer T, et al. Technical and procedural comparison of two different cryoballoon ablation systems in patients with atrial fibrillation. J Interv Card Electrophysiol. 2021. https://doi.org/10.1007/s10840-021-01035-6.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Miyazaki S, Taniguchi H, Hachiya H, Nakamura H, Takagi T, Iwasawa J, et al. Quantitative analysis of the isolation area during the chronic phase after a 28-mm second-generation cryoballoon ablation demarcated by high-resolution electroanatomic mapping. Circ Arrhythm Electrophysiol. 2016;9(5):e003879. https://doi.org/10.1161/circep.115.003879.

    Article  PubMed  Google Scholar 

  6. Kuniss M, Greiß H, Pajitnev D, Akkaya E, Deubner N, Hain A, et al. Cryoballoon ablation of persistent atrial fibrillation: feasibility and safety of left atrial roof ablation with generation of conduction block in addition to antral pulmonary vein isolation. Europace. 2017;19(7):1109–15. https://doi.org/10.1093/europace/euw146.

    Article  PubMed  Google Scholar 

  7. Cheng T. Natural Convection in Porous Media: External Flow. In: S. Kakac WA, R. Viskanta (Eds.), editor. Natural convection: fundamentals and applications. Martinus Nijhoff Publisher, The Haque, The Netherlands; 1985. 475–513.

  8. Friberg TR, Tano Y, Machemer R. Streaks (schlieren) as a sign of rhegmatogenous detachment in vitreous surgery. Am J Ophthalmol. 1979;88(5):943–4. https://doi.org/10.1016/0002-9394(79)90579-8.

    Article  CAS  PubMed  Google Scholar 

  9. Sotsuka Y, Wakatsuki H, Matsuda K. Schlieren phenomenon for identification of lymphorrhea point. Plast Reconstr Surg Glob Open. 2022;10(4):e4269. https://doi.org/10.1097/gox.0000000000004269.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tomaiko-Clark E, Bai R, Khokhar M, Su WW. A tale of two balloons: technical and procedural difference between cryoballoon systems. Curr Opin Cardiol. 2022;37(1):62–7. https://doi.org/10.1097/hco.0000000000000942.

    Article  PubMed  Google Scholar 

  11. Miyazaki S, O’Connell H, Maus B. Parameters associated with acute morphometric lesion dimensions created by cryocatheters. J Interv Card Electrophysiol. 2019;54(2):109–18. https://doi.org/10.1007/s10840-018-0452-x.

    Article  PubMed  Google Scholar 

  12. Mizutani Y, Yanagisawa S, Kanashiro M, Yamashita D, Yonekawa J, Makino Y, et al. Earliest pulmonary vein potential-guided cryoballoon ablation is associated with better clinical outcomes than conventional cryoballoon ablation: a result from two randomized clinical studies. J Cardiovasc Electrophysiol. 2021;32(11):2933–42. https://doi.org/10.1111/jce.15246.

    Article  PubMed  Google Scholar 

  13. Hürzeler D. [Cryoapplication in the field of ORL (author’s transl)]. Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis. 1979;68(37):1188–91.

  14. Lee C, Baek S, Lee J, Hwang G, Jeong S, Park SW. Development of a closed-loop J-T cryoablation device with a long cooling area and multiple expansion parts. Med Eng Phys. 2014;36(11):1464–72. https://doi.org/10.1016/j.medengphy.2014.07.017.

    Article  PubMed  Google Scholar 

  15. Andrade JG. Cryoablation for atrial fibrillation. Heart Rhythm 02. 2020;1(1):44–58. https://doi.org/10.1016/j.hroo.2020.02.004.

    Article  Google Scholar 

  16. Kuniss M, Akkaya E, Berkowitsch A, Zaltsberg S, Greiss H, Rechner M, et al. Left atrial roof ablation in patients with persistent atrial fibrillation using the second-generation cryoballoon: benefit or wasted time? Clin Res Cardiol. 2020;109(6):714–24. https://doi.org/10.1007/s00392-019-01560-5.

    Article  PubMed  Google Scholar 

  17. Manolis AS, Manolis AA. Pulmonary vein reconnection following cryo-ablation: mind the “gap” in the carinae and the left atrial appendage ridge. Indian Pacing Electrophysiol J. 2019;19(4):125–8. https://doi.org/10.1016/j.ipej.2019.07.001.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan

    Yoshiaki Mizutani, Gen Fujiwara, Yosuke Kasai, Atomu Tajima, Yuichiro Makino, Hitomi Suzuki, Takatsugu Hiramatsu, Hitoshi Ichimiya, Yasuhiro Uchida, Junji Watanabe & Masaaki Kanashiro

  2. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

    Yoshiaki Mizutani, Satoshi Yanagisawa, Yasuya Inden & Toyoaki Murohara

Authors
  1. Yoshiaki Mizutani
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  2. Satoshi Yanagisawa
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Corresponding author

Correspondence to Yoshiaki Mizutani.

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This study was approved by the Ethics Committee of Yokkaichi Municipal Hospital.

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Mizutani, Y., Yanagisawa, S., Fujiwara, G. et al. Evaluation of the direction and extent of ice formation during cryoballoon ablation: an experimental study. J Interv Card Electrophysiol 66, 981–989 (2023). https://doi.org/10.1007/s10840-022-01411-w

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  • DOI: https://doi.org/10.1007/s10840-022-01411-w

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