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J Thorac Cardiovasc Surg 2006;131:403-411
© 2006 The American Association for Thoracic Surgery

Evolving Technology

Epicardial beating heart cryoablation using a novel argon-based cryoclamp and linear probe

^a New York Presbyterian Hospital–Weill Cornell Medical Center, Department of Cardiothoracic Surgery, New York, NY
^b New York Presbyterian Hospital–Weill Cornell Medical Center, Department of Anesthesiology, New York, NY
^c New York Presbyterian Hospital–Weill Cornell Medical Center, Department of Medicine, New York, NY

Read at the Thirty-first Annual Meeting of The Western Thoracic Surgical Association, Victoria, BC, Canada, June 22-25, 2005.

Received for publication June 16, 2005; revisions received October 18, 2005; accepted for publication October 28, 2005.

^_* Address for reprints: Charles A. Mack, MD, Department of Cardiothoracic Surgery New York-Presbyterian Hospital, Weill Cornell Medical College, M404, 525 East 68th St, New York, NY 10021 (Email: cmack{at}med.cornell.edu).

OBJECTIVE: Epicardial, beating heart cryoablation for the treatment of atrial fibrillation may be limited by heat from intracardiac blood flow. We therefore evaluated the ability to create cryolesions using an argon-based cryoclamp device, which temporarily occludes blood flow and facilitates transmurality.

METHODS: Six mongrel dogs underwent sternotomy. A clamp employing a 10-cm argon-based linear cryoablation device was used epicardially to isolate the pulmonary veins and left atrial appendage. After clamping of lesions, the probe was removed from the cryoclamp device, and the remaining linear lesions, analogous to the Cox maze III, were performed. Pulmonary vein stenosis was evaluated with the use of magnetic resonance imaging. Left atrial function and pulmonary venous flow velocities were assessed with transesophageal echocardiography. Transmurality was confirmed both electrically and histologically. Animals were then put to death at 30 days.

RESULTS: All acute and chronic cryoclamp lesions produced conduction block. There was no change in right (RPV) or left pulmonary vein (LPV) diameter on the basis of magnetic resonance imaging at baseline and at planned death (RPV-1, 19.6 ± 2.9 mm vs 16.9 ± 2.8 mm, P = .22; RPV-2, 13.2 ± 2.0 mm vs 11.8 ± 1.6 mm, P = .22; and LPV, 12.2 ± 2.4 mm vs 11.2 ± 1.9 mm, P = .30). Left atrial function and pulmonary venous flow velocities were unchanged. Tissue sections determined transmurality in 93% of cryoclamp lesions and 84% of linear ablations performed with the 10-cm malleable probe.

CONCLUSIONS: Epicardial application of this cryoclamp device on the beating heart produced transmural lesions, which persisted 30 days. Linear epicardial cryoablation was not as effective as the cryoclamp device at producing consistent transmural lesions. This novel, versatile device may be useful in treating patients with atrial fibrillation on the beating heart without cardiopulmonary bypass.

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