The purpose of this text is to provide a comprehensive resource on cryoablation, including tissue effects, cryotechnology, and clinical applications.
Cryoablation has unique properties that are very different from other energy sources used for ablation of cardiac or other tissues. Because freezing has minimal effects on elastic collagen structures and has less-detrimental effects on local microcirculation, tissue “architecture” remains preserved to some extent and tissues also heal better. This decreases the risk for stricture formation, stenosis, and ulceration of ablated areas. These features of cryoablation are especially useful when lesions have to be placed in close proximity to important cardiac structures such as the His bundle, pulmonary veins, coronary arteries, esophagus, and phrenic nerve.
Despite all these attractive features, cryoablation is underutilized because the more complex catheter design decreases maneuverability and the cryocatheters that are currently commercially available operate at –80°C, requiring longer application times.
Recently developed balloon-based cryotechnology, as well as the availability of “colder” technologies utilizing critical nitrogen, super-critical nitrogen (–180°C to –196°C), and other agents, has the potential to overcome these limitations and increase utilization of cryoablation in electrophysiology laboratories. Further development of these technologies will be extremely useful for ablation of ventricular tachycardia and for septal ablation in hypertrophic cardiomyopathy.
-- Audrius J. Bredikis, MD, FACC and David J. Wilber, MD, FAHA, FACC
Key Features
- Deepen your understanding of all aspects of cryoablation in cardiac arrhythmias while building your clinical knowledge of the latest technologies and procedures.
- Master the latest cryoablation procedures for adult patients (AVNRT cryoablation, WPW and septal pathways, atrial flutter, atrial fibrillation, balloon-based cryoablation, RVOT cryoablation); pediatric and adolescent patients (AVNRT cryoablation, WPW cryoablation, cryoablation for pediatric coronary sinus); and cardiac surgery patients (left atrial cryoablation procedure for AF; epicardial cryoablation of AF in patients undergoing mitral valve surgery; epicardial ablation with argon-based cryo-clamp; cryoablation of ventricular tachycardias).
- Implement truly diverse perspectives and worldwide best practices from a team of contributors and editors comprised of the world's leading experts.
- Find information quickly and easily thanks to consistent and tightly focused chapters and a full-color design with tables, illustrations, and high-quality images.
Website Features
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Contents
Section I - Fundamental Aspects of Cryoablation
Chapter 1 - History of Cardiac Cryosurgery and Cryoablation
- Joule–Thomson Effect
- Curing Atrioventricular Node Reentry Tachycardia with Preserved Atrioventricular Nodal Conduction using the Cryoprobe as a “Reversible Knife”
- Cardiac Cryosurgery in the Absence of Cardiopulmonary Bypass
- Cryosurgery for Ventricular Tachycardia
- Cryosurgery in the Management of Atrial Fibrillation
- Transition to the Intravascular Catheter-Mediated Delivery of Cryothermy
- Conclusion
- References
Chapter 2 - Mechanisms of Cryoablation
- Mechanical and Molecular Forces
- Freeze/Thaw Cycle
- Thermal Dosimetry
- Characteristics of the Cryogenic Lesion
- Clinical Implications
- Conclusions
Chapter 3 - Factors That Determine Cryolesion Formation and Cryolesion Characteristics
- Freezing Duration and “Lethal” Temperatures
- Rate of Freezing
- Double Freezing
- Effects of Contact Pressure
- Effects of Catheter Size on Cryolesion Formation
- Effects of Blood Flow on Cryolesion Size
- Effects of Probe Temperature on Cryolesion Size
- Effects of Blood Flow on Cryolesion Size
- Lesion Characteristics
- Comparison of cryolesion with Radiofrequency Lesion
- Epicardial Cryoablation
- Epicardial Ablation with Argon Probes
- Methods
- Results
- Major Findings
- Transmurality
- Study Limitations
- Epicardial Ablation with Critical Nitrogen
- Purpose
- Methods
- Results
- Conclusions
- Epicardial Lesion Depth and Myocardial Thickness
- Effect of Scar and Fat Tissue on Cryolesion Formation
- Comparison of Lesion Sizes with Open Irrigation Radiofrequency
- Effect on Pain Perception during Ablation
- Cryoadhesion
Chapter 4 - Canine Model of Esophageal Injury during Atrial Fibrillation Ablation
- Esophageal Injury after Ablation with Ultrasound Energy
- Esophageal Injury after Ablation with Radiofrequency Energy
- Esophageal Injury after Cryoablation
- Conclusions
Chapter 5 - Cryoablation Effects on Pulmonary Veins in Experimental Settings
- Study Design
- Acute and Short-Term Survival Studies: Feasibility and Safety of Cryoablation for Pulmonary Vein Isolation Using 4-Minute Cryoapplication
- Long-Term Survival Studies: Assessment of Cryoablation Freezing Time for Permanent Pulmonary Vein Electrical Isolation
- Histologic Findings
- Discussion
Chapter 6 - Cryoablation Effects on Coronary Arteries and Veins
- Physiological Effects
- Veins
Section II - Cryotechnology Overview
Chapter 7 - Medtronic CryoCath Technology
- Cryo: The Scientific Basis of Cryoablation and Design of Cryoablation Systems
- What Is Cryoablation?
- The Concepts of Heat and Cold
- Thermal Conduction and Convection
- Refrigeration
- Phase Change and the Joule–Thomson Effect
- Application to Catheter Ablation Therapy: Refrigeration Cycle in Cryocatheters, Thermal Convection in Cryocatheters, Design Considerations and Materials
- Medtronic Cryocath Cryoablation Systems
- Overview of Company History and Product Development
- Cryoablation Catheters and Console
- Safety Features
- Cryoablation Catheter Manufacturing Process
- Arctic Front Cryoablation Balloon Catheter System
- A Balloon-Catheter Approach to Facilitate Pulmonary Vein Isolation
- Comparing Cryoballoon and Focal Catheters
- Arctic Front Components
- Using Arctic Front
- Future Directions in Cryotechnology
- Cryoballoon for Ventricular Tachycardia
- Linear Cryoablation
- Combining Radiofrequency and Cryoablation
Chapter 8 - Boston Scientific Technology
- Introduction
- The Making of a Transmural Cryolesion
- Bsc Cryoballoon Ablation System
- Vein Access
- Anatomic Approximation
- Effective Lesion (Energy Transfer)
Chapter 9 - Evolving Concepts
- Materials and Methods
- Joule–Thompson Cooling Process
- Near-Critical Nitrogen Cooling
- Critical Cryogen Generators and Scalability
- Summary
Section III - Clinical Applications
Chapter 10 - Reversible Effects of Cryoablation and Atrioventricular Node Modification
- Reversible Effects of Cryoablation
- Cellular Basis
- Practical Cryomapping
- Atrioventricular Nodal Reentrant Tachycardia Cryoablation
- Practical Approach
- Reported Results
- Cryoablation of the Atrioventricular Node
- Conclusion
Chapter 11 - AVNRT Cryoablation and Comparison with RF Ablation
- Atrioventricular Nodal Reentry Tachycardia
- Catheter Ablation
- Experimental Data
- Materials and Methods
- Results: Electrophysiology, Histology
- Conclusion of the Experimental Data
- Acute Results of Cryoablation in Humans
- Long-Term Results after Cryoablation
- Conclusions
Chapter 12 - Cryoablation of Septal Accessory Pathways
- Cryoablation Energy Features in the Atrial Septal Region
- Cryoablation versus Radiofrequency Ablation in Septal Accessory Pathways Ablation
- Recurrence Rate
- Atrioventricular Block Risk
- New Perspectives in Septal Accessory Pathways Ablation
- Conclusions
Chapter 13 - Cryoablation of Atrial Flutter
- Epidemiology and Pharmacoeconomics
- Symptoms and Clinical Features
- Pathophysiology
- Cryoablation from Bench to Bedside
- Preclinical Studies Demonstrate the Feasibility of Cryoablation
- Basic Features of the Cryoablation Procedure
- End Points to Assess the Safety and Efficacy of Cryoablation in Clinical Studies
- Clinical Studies Demonstrate the Safety and Efficacy of Cryoablation
Chapter 14 - Focal Cryoablation of Atrial Fibrillation
- Current Status for Atrial Fibrillation Ablation
- Basic Principle of Cryoablation
- Clinical Application of Cryoablation
- Conclusions
Chapter 15 - Balloon-Based Cryoablation of Atrial Fibrillation
- Evolution of the Cryoballoon Concept
- Cryoballoon-Based Procedures
- Sophisticated Strategies to Improve the Cryoballoon-Based Catheter Ablation of Atrial Fibrillation
- Right Ventricular Rapid Pacing
- Cryoballoon-Guided Pulmonary Vein Isolation by Transesophageal Echocardiography
- Pressure-Guided Cryoballoon Isolation of the Pulmonary Veins
- Future Directions and Unresolved Questions
- Safety Aspects
- Conclusions
Chapter 16 - Cryocatheter Ablation of Ventricular Tachycardia
- Concerns about the Role of Cryoablation in Ventricular Tachycardias
- Results from Animal Studies
- Cryoablaton of Ventricular Tachyarrhythmias in Humans
- Cryoablation of Left Ventricular Tachycardias
- Cryoablation of Right Ventricular Outflow Tract Tachycardias
- Observations during Mapping and Ablation
- Procedural Results
- Conclusions
- Outlook
Chapter 17 - Role of Cryoablation for Superior Vena Cava Isolation and Ablation of Inappropriate Sinus Tachycardia
- Introduction
- Superior Vena Cava: Relevant Anatomy
- Arrhythmias Associated with Superior Vena Cava
- Cryoablation
- Phrenic Nerve Injury during Radiofrequency Ablation Procedures
- Using Cryoablation for Superior Vena Cava–Related Arrhythmia Ablation Procedures
- Avoiding Superior Vena Caval Stenosis
- Avoiding Phrenic Nerve Injury
- Superior Vena Caval Isolation
- Atrial Tachycardia Ablation
- Inappropriate Sinus Tachycardia Ablation
- Pulmonary Vein Isolation
- Conclusion
Chapter 18 - Cryoablation in Pediatrics
- Atrioventricular Block
- Coronary Artery Damage and Thrombus Formation
- Unique Lesion Properties in Pediatrics
- Cryoablation of Accessory Pathways
- Cryoablation of Atrioventricular Node Reentry Tachycardia
- Other Tachycardia Substrates
- Procedural Considerations
- Epicardial Cryoablation
- Disadvantages of Cryoablation
- Summary
Section IV - Current Applications in Cardiac Surgery
Chapter 19 - Endocardial Cryoablation of Atrial Fibrillation
- Electrophysiology of Atrial Fibrillation
- Surgical Ablation: History
- Cryoenergy Ablative Tools
- Endocardial Cryoablation
- Minimally Invasive
- Conclusions
Chapter 20 - Cryosurgery for Ventricular Tachycardia
- Historical Background
- Rationale for Using Cryoablation
- Cryoablation Technique
- How to Do It
- Results
- Discussion
- Which Patients Would Benefit from the Procedure?
- What Technique Should Be Used?
- Conclusion
About the Authors
- Audrius J. Bredikis, MD, FACC, Cardiac Electrophysiology, Holmes Regional Medical Center, Melbourne, Florida; Clinical Associate Professor of Medicine, University of Central Florida.
- David J. Wilber, MD, FAHA, FACC, George M. Eisenberg Professor of Cardiovascular Sciences; Director, Cardiovascular Institute; Director, Division of Cardiology, Medical Director, Electrophysiology Laboratory, Loyola University Medical Center, Maywood, Illinois.
Product Details
- Hardcover: 256 pages
- Publisher: Saunders; 1 Har/Psc edition (2011)
- Language: English
- ISBN-10: 1437716156
- ISBN-13: 978-1437716153
- Product Dimensions: 10.5 x 7.5 x 0.7 inches
List Price: $149.00