Effects of temporal application parameters on lesion dimensions during transvenous catheter cryoablation

Abstract

Background: Transvenous catheter cryoablation is a novel technique for treating cardiac arrhythmias. However, the relative importance of temporal application parameters on lesion dimension and clinical efficacy has not been studied. Methods and Results: We investigated the effects of (1) application duration: single 2.5 (2.5 x 1) versus single 5 versus double 2.5 (2.5 x 2) versus double 5 (5 x 2) minutes, (2) number of freeze-thaw cycles: single versus double, and (3) electrode contact area: horizontal versus vertical orientation, on the lesion diameter and depth during catheter cryoablation (10F, 6.5-mm tip-electrode, CryoCor™, San Diego) in a thigh muscle preparation. A total of 175 lesions (horizontal = 90, vertical = 85) were created in thigh muscle preparations on 10 swine. The lesion diameter and depth were significantly greater using 2.5 x 2 and 5 x 2 application modes as compared with 2.5 x 1 applications (P < 0.05). Horizontal tip-electrode orientation produced larger lesion diameter (P < 0.05), but not lesion depth as compared with vertical orientation. Multivariate analysis demonstrated that both tip-electrode orientation and duration of freeze >2.5 minutes were independent predictors for lesion diameter (P < 0.001). However, only duration of freeze >2.5 minutes was an independent predictor for lesion depth (P < 0.001). Conclusions: The dimensions of lesions created by catheter cryoablation are affected by mode of cryoablation application and electrode orientation. Increasing the duration of application, employing multiple freeze-thaw cycles at shorter cycle durations, and orienting the catheter to enhance/increase tissue contact can create a larger lesion.