Combined Radiofrequency Ablation-Cooling Catheter for Reversible Cryothermal Mapping and Ablation
Tóm tắt
Reversible cryothermal mapping of cardiac arrhythmias has beenperformed intraoperatively. However, a steerable cooling catheter forreversible mapping has not yet been developed. We therefore developed andtested a cooling system consisting of a +15°C hypertonic salinereservoir and a 7F steerable catheter also capable of radiofrequency (RF)ablation. Using excised ovine hearts placed in a 37°C circulating salinebath, we measured the temperatures at depths of 0 mm, 1 mm, and 2 mm. Thetemperature after 90 seconds of cooling was 16.5 ± 2.1°C at 0 mmcompared to 23.9 ± 4.1°C at 1 mm and 31.1 ± 3.9°C at 2mm depth (p < 0.01). These data suggest that a 7F steerable combined RFablation–cooling catheter may achieve temperatures suitable formapping arrhythmias such as atrial tachycardias and right ventricularoutflow tract tachycardias. Further enhancements to achieve lowertemperatures at depth may be needed to reversibly map other arrhythmiassuch as left ventricular tachycardias.
Tài liệu tham khảo
Manolis AS, Wang PJ, Estes NAM. Radiofrequency ablation for cardiac tachyarrhythmias. Ann Intern Med 1994;121:452.
Morady F, Calkins H, Langberg JJ, Armstrong WF, de-Buitleir M, el-Atassi R, Kalbfleisch SJ. A prospective randomized comparison of direct current and radiofrequency ablation of the atrioventricular junction. J Am Coll Cardiol 1993;21:102.
Margolis PD, Roman CA, Moulton KP, Calame J, Wang X, Lazzara R, Jackman WM. Radiofrequency catheter ablation of left and right ectopic atrial tachycardia (abstract). Circulation 1990;82:2854.
Jackman WM, Wang XZ, Friday KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff–Parkinson–White syndrome) by radiofrequency current. N Engl J Med 1991;324:1605–1611.
Lee MA, Morady F, Kadish A, Schamp DJ, Chin MC, Scheinman MM, Griffin JC, Lesh MD, Pederson D, Goldberger J. Catheter modification of the atrioventricular junction with radiofrequency energy for control of atrioventricular nodal reentry tachycardia. Circulation 1991;83:827–835.
Kay GN, Epstein AE, Dailey SM, Plumb VJ. Selective radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal reentrant tachycardia. Evidence for involvement of perinodal myocardium within the reentrant circuit. Circulation 1992:85:1675–1688.
Jackman WM, Beckman KJ, McClelland JH, et al. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow pathway conduction. N Engl J Med 1992;327:313–318.
Windle JR, Miles WM, Zipes DP, Prystowsky EN. Subthreshold conditioning stimuli prolong human ventricular refractoriness. Am J Cardiol 1986; 57:381–386.
Skale BT, Kallok MJ, Prystowsky EN, Gill RM, Zipes DP. Inhibition of premature ventricular extrastimuli by subthreshold conditioning stimuli. J Am Coll Cardiol 1985; 6:133–140.
Shenasa M, Cardinal R, Kus T, Savard P, Fromer M, Page P. Termination of sustained ventricular tachycardia by ultrarapid subthreshold stimulation in humans. Circulation 1988; 78:1135–1143.
Gang ES, Peter T, Nalos PC, Meesman M, Karageuzian HS, Mandel WJ, Oseran DS, Myers MR. Subthreshold atrial pacing in patients with left-sided accessory pathway: an effective new method for terminating reciprocating tachycardia. J Am Coll Cardiol 1988; 11:515–521.
Gallagher JD, Del Rossi AJ, Fernandez J, Markanhao V, Strong MD, White M, Gessman LJ. Cryothermal mapping of recurrent ventricular tachycardia in man. Circulation 1985; 71:733.
Gessman LJ, Agarwal JB, Endo T, Helfant R. Localization and mechanism of ventricular tachycardia by ice mapping 1 week after the onset of myocardial infarction in dogs. Circulation 1983;68:657.
Gessman LJ, Endo T, Egan J, Gallagher JD, Hastie R, Maroko PR. Dissociation of the site of origin from the site of cryo-termination of ventricular tachycardia. PACE 1983;6:1293.
Ohkawa S-I, Hackel DB, Mikat EM, Gallagher, JJ, Cox JL, Sealy WC. Anatomic effects of cryoablation of the atrioventricular conduction system. Circulation 1982; 65:1155–1162.
Avitall B, Dhala A, Hare J, Jazayeri M, Sra J, Akhtar M. Ablation of left sided accessory pathways: criteria for catheter design (abstract). PACE 1992; 15:293.
Page PL, Cardinal R, Shenasa M, Keltenbrunner W, Cossette R, Nadeau R. Surgical treatment of ventricular tachycardia. Regional cryoablation guided by computerized epicardial and endocardial mapping. Circulation 1989;80:124.
Fujino H, Thompson RP, Germroth PG, Harold ME, Swindle MM, Gillette PC. Histologic study of chronic catheter cryoablation of atrioventricular conduction in swine. Am Heart J 1993;125:1632.
Gillette PC, Swindle MM, Thompson RP, Case CL. Transvenous cryoablation of the bundle of His. PACE 1991;14:504.
Hidden FA, Lavergne TL, Verdier JB, et al. Closed-chest modification of canine atrioventricular conduction using a cryogenic catheter (abstract). Circulation 1990;82(Suppl 3):III–720.
Yagi Y, Schuessler RB, Boineau JP, et al. Closed heart cryomodification of atrioventricular conduction—Is it feasible? (Abstract.) Circulation 1992;86(Suppl 2):II–445.
Wang PJ, Schoen F, Guo HS, et al. Catheter cryoablation of myocardium (abstract). Circulation 1989;80(Suppl 1):II–222.
Okishige K, Stanhope W, Couper G, et al. Feasibility of catheter cryoablation of epicardial ventricular tachycardia. PACE 1993; 16:923.
Wang PJ, Aronovitz M, Schoen FJ, et al. Catheter cryoablation under the mitral annulus: a new method of accessory pathway ablation? J Am Coll Cardiol 1993; 16:357A.
Holman WL, Ikeshita M, Lease JG, Smith PK, Ferguson TB Jr, Cox JL. Elective prolongation of atrioventricular conduction by multiple cryolesions. J Thorac Cardiovasc Surg 1982;84:554.
Caceres J, Akhtar M, Werner P, Jazayeri M, McKinnie J, Avitall B, Tchou P. Cryoablation of refractory sustained ventricular tachycardia due to coronary artery disease. Am J Cardiol 1989;63:296.
Klein GJ, Harrison L, Ideker RF, Smith WM, Kasell J, Wallace AG, Gallagher JJ. Reaction of the myocardium to cryosurgery: electrophysiology and arrhythmogenic potential. Circulation 1979;59:364–371.
Klein GJ, Sealy WC, Pritchett ELC, Harrison L, Hackel DB, Davis D, Kasell J, Wallace AG, Gallagher JJ. Cryosurgical ablation of the atrioventricular node-his bundle: longterm follow-up and properties of the junctional pacemaker. Circulation 1980; 61:8–14.
Cox, JL, Ferguson TB, Lindsay BD, Cain ME. Perinodal cryosurgery for atrioventricular node reentry tachycardia in 23 patients. J Thorac Cardiovasc Surg 1990;99:440–450.
Holman WL, Ikeshita M, Douglas JM, Smith PK, Lofland GK, Cox JL. Ventricular cryosurgery: short-term effects on intramural electrophysiology. Ann Thorac Surg 1983;35:386.
Camm J, Ward MB, Spurrel RAJ, Rees GM. Cryothermal mapping and cryoablation in treatment of refractory cardiac arrhythmias. Circulation 1980;62:67.
Cox JL, Holman WL, Cain ME. Cryosurgical treatment of the atrial ventricular node reentrant tachycardia. Circulation 1987;76:1329.
El-Sherif N, Mehra R, Gough WB, Zeiler RH. Reentrant ventricular arrhythmias in the late myocardial infarct period: interruption of reentrant circuits by cryothermal techniques. Circulation 1983;68:644.
Guiraudon GM, Thakur RK, Klein GJ, Yee R, Guiraudon CM, Sharma A. Encircling endocardial cryoablation for ventricular tachycardia after myocardial infarction: experience with 33 patients. Am Heart J 1994;128:982.
Hariman RJ, Hu D, Beckman KJ, Gomes JAC, Bauman JL, El-Sherif N. Cryothermal mapping of the sinus node in dogs: a simple method of localizing dominant and latent pacemakers. Cardiovas Res 1989;23:231.
Harrison L, Gallagher JJ, Kasell J, Anderson RH, Mikat E, Hackel DB, Wallace AG. Cryosurgical ablation of the AV node-His bundle. A new method for producing AV block. Circulation 1977;55:463.
Keim S, Werner P, Jazayeri M, Akhtar M, Tchou P. Localization of the fast and slow pathways in atrioventricular nodal reentrant tachycardia by intraoperative ice mapping. Circulation 1992;86:919.
Slater, AD, Singer I, Stavens C, Zee-Cheng C, Gray LA Jr. Repetitive intraoperative mapping and cryotherapy improve the results of endocardial resection for ventriculatachycardia. J Cardiovas Surg 1990;31:788.