Document Detail


Transmural atrial fibrosis after epicardial and endocardial argon-powered CryoMaze ablation.
MedLine Citation:
PMID:  21395689     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The CryoMaze procedure is usually limited to endocardial ablation under cardio-pulmonary bypass. Epicardial ablation is considered inferior as endocardial islets of atrial tissue could theoretically remain viable, protected from cryoinjury by epicardial fat and endocardial circulating warm blood. Novel argon-powered cryoprobes with lower ablation temperatures have recently become available. It is unclear if these instruments can reliably induce transmural atrial fibrosis by epicardial cryoablation on the beating heart.
METHODS: Ten sheep were divided into two equal groups. CryoMaze ablations were applied using an argon-powered cryoprobe with an ablation temperature of -185°C. In the control group, standardized ablations (n = 50) were applied endocardially under cardiopulmonary bypass. In the experimental group, corresponding ablations (n = 50) were applied epicardially on the beating heart. Postoperatively the animals were monitored for 30 days. At necropsy, the lesions were explanted and analyzed histologically for evidence of transmural fibrosis.
RESULTS: Two animals in the control group and one animal in the experimental group died prematurely. Autopsy of the remaining animals showed that all lesions (n = 70) had retained their structural integrity. In the control group, histology demonstrated transmural fibrosis in 94% (28/30) of the endocardially applied lesions. In the experimental group, histology demonstrated transmural fibrosis in 95% (38/40) of the epicardially applied lesions. Statistical analysis revealed no significant difference between the two groups (p = 0.96).
CONCLUSION: Argon-powered epicardial cryoablation on the beating heart is as efficient in inducing transmural fibrosis as the traditional technique of endocardial ablation under cardio-pulmonary bypass.
Authors:
Robert P Gallegos; Andrew L Rivard; Taufiek K Rajab; B Chir; Jan D Schmitto; Matthew T Lahti; Nicole Kirchhof; Richard W Bianco
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of cardiac surgery     Volume:  26     ISSN:  1540-8191     ISO Abbreviation:  J Card Surg     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-14     Completed Date:  2011-07-26     Revised Date:  2011-08-10    
Medline Journal Info:
Nlm Unique ID:  8908809     Medline TA:  J Card Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  240-3     Citation Subset:  IM    
Copyright Information:
© 2011 Wiley Periodicals, Inc.
Affiliation:
Experimental Surgical Services, University of Minnesota, Minneapolis, Minnesota, USA. rgallegos@partners.org
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MeSH Terms
Descriptor/Qualifier:
Animals
Atrial Fibrillation / surgery*
Disease Models, Animal
Endocardium / surgery*
Fibrosis / etiology,  pathology
Heart Atria / pathology*
Laser Therapy / adverse effects*,  instrumentation
Lasers, Excimer / adverse effects,  therapeutic use*
Myocardium / pathology*
Postoperative Complications*
Pulmonary Veins / surgery
Sheep
Comments/Corrections
Erratum In:
J Card Surg. 2011 May;26(3):341
Note: Chir, B [removed]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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