IHU LIRYC ANR-10-IAHU-04, Electrophysiology and Heart Modeling Institute, University of Bordeaux, Bordeaux-Pessac, France.
Hôpital Cardiologique du Haut Lévêque, CHU Bordeaux, Bordeaux-Pessac, France.
J Cardiovasc Electrophysiol. 2021 Mar;32(3):570-577. doi: 10.1111/jce.14907. Epub 2021 Feb 1.
Ultralow temperature cyroablation (ULTC) is designed to create focal, linear, and circumferential lesions. The aim of this study was to assess the safety, efficacy, and durability of atrial and ventricular ULTC lesions in preclinical large animal models.
The ULTC system uses nitrogen near its liquid-vapor critical point to cool 11-cm ablation catheters. The catheter can be shaped to specific anatomies using pre-shaped stylets. ULTC was used in 11 swine and four sheep to create atrial (pulmonary vein isolation and linear ablation) and ventricular lesions. Acute and 90-day success were evaluated by intracardiac mapping and histologic examination. Cryoadherence was observed during all ULTC applications, ensuring catheter stability at target locations. Local electrograms were completely eliminated immediately after the first single-shot ULTC application in 49 of 53 (92.5%) atrial and in 31 of 32 (96.9%) ventricular applications. Lesion depth as measured on histology preparations was 1.96 ± 0.8 mm in atrial and 5.61 ± 2.2 mm in ventricular lesions. In all animals, voltage maps and histology demonstrated transmural and durable lesions without gaps, surrounded by intact collagen fibers without injury to surrounding tissues. Transient coronary spasm could be provoked with endocardial ULTC in the left ventricle in close proximity to a coronary artery.
ULTC created effective and efficient atrial and ventricular lesions in vivo without procedural complications in two large animal models. ULTC lesions were transmural, contiguous, and durable over 3 months.
超低温冷冻消融（ULTC）旨在创建局灶性、线性和环形病变。本研究旨在评估在临床前大型动物模型中，心房和心室 ULTC 病变的安全性、有效性和持久性。
ULTC 系统使用接近其液-气相临界点的氮气来冷却 11cm 的消融导管。导管可以使用预成型的芯丝塑造成特定的解剖形状。ULTC 用于 11 头猪和 4 只绵羊，以创建心房（肺静脉隔离和线性消融）和心室病变。通过心内映射和组织学检查评估急性和 90 天的成功率。在所有 ULTC 应用中均观察到冷冻黏附，确保导管在目标位置的稳定性。在 53 次心房（92.5%）和 32 次心室（96.9%）应用中的 49 次和 31 次中，单次单次 ULTC 应用后立即完全消除局部电图。组织学标本上测量的病变深度为心房 1.96±0.8mm 和心室 5.61±2.2mm。在所有动物中，电压图谱和组织学均显示出无间隙的透壁和持久病变，周围环绕着完整的胶原蛋白纤维，周围组织无损伤。在左心室与冠状动脉紧密相邻的心内膜 ULTC 中可诱发短暂性冠状动脉痉挛。
在两种大型动物模型中，ULTC 可在体内创建有效且高效的心房和心室病变，无程序并发症。ULTC 病变是透壁的、连续的且在 3 个月以上持久。
