Safety and Feasibility of Cryothermal Ablation Within the Mid‐ and Distal Coronary Sinus
Identifieur interne : 000C29 ( Istex/Corpus ); précédent : 000C28; suivant : 000C30Safety and Feasibility of Cryothermal Ablation Within the Mid‐ and Distal Coronary Sinus
Auteurs : Allan C. Skanes ; Douglas L. Jones ; Patrick Teefy ; Colette Guiraudon ; Raymond Yee ; Andrew D. Krahn ; George J. KleinSource :
- Journal of Cardiovascular Electrophysiology [ 1045-3873 ] ; 2004-11.
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- KwdEn :
Abstract
Introduction: The aim of this study was to assess the safety and feasibility of catheter‐based cryothermal ablation lesions in the mid‐ and distal coronary sinus. Methods and Results: Cryothermal ablation lesions were delivered using a 7‐French catheter at the mid‐ (n = 13) and distal (n = 12) coronary sinus in 14 swine under general anesthesia. Lesions were delivered for 2 or 4 minutes in a 1:2 randomized ratio such that seven 2‐minute lesions and eighteen 4‐minute lesions were delivered to a maximum negative temperature of −70°C. Integrity of the circumflex artery was assessed by angiography before and after each lesion application. In five animals, arterial Doppler flow velocity was continuously monitored and coronary flow reserve assessed. Histologic assessment of the left AV ring was made after a 48‐hour survival period and lesions graded for depth and transmurality. Eighteen of 25 lesions were >3 mm deep: five of seven 2‐minute lesions and thirteen of eighteen 4‐minute lesions. Lesions were transmural in 18 of 25 cases. Two transmural lesions were limited in depth due to their epicardial position. One 2‐minute mid‐coronary sinus lesion was not found. Adherent thrombus was seen grossly in the coronary sinus at one site and only on microscopic examination in three other lesions. Angiography demonstrated no arterial spasm or thrombosis. Continuous‐flow Doppler remained unchanged throughout lesion production. Coronary flow reserve was unchanged (1.7 ± 0.8 preablation vs 1.7 ± 1.0 postablation, P = 0.6). The media and intima were preserved in all cases. Necrosis of the adventitia was seen in one arterial segment. Conclusion: Catheter‐based cryoablation can produce lesions in the musculature of the adjacent atrium and ventricle when accessed from the coronary sinus without significant injury to the coronary sinus or adjacent artery. This method has potential application as the ablation method of choice when such lesions are required.
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DOI: 10.1046/j.1540-8167.2004.04116.x
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Jones</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation><affiliation><mods:affiliation>Physiology and Pharmacology</mods:affiliation></affiliation></author><author><name sortKey="Teefy, Patrick" sort="Teefy, Patrick" uniqKey="Teefy P" first="Patrick" last="Teefy">Patrick Teefy</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation></author><author><name sortKey="Guiraudon, Colette" sort="Guiraudon, Colette" uniqKey="Guiraudon C" first="Colette" last="Guiraudon">Colette Guiraudon</name><affiliation><mods:affiliation>Pathology, University of Western Ontario, London, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation></author><author><name sortKey="Krahn, Andrew D" sort="Krahn, Andrew D" uniqKey="Krahn A" first="Andrew D." last="Krahn">Andrew D. Krahn</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation></author><author><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:A3A0CC7C02F2B623ED4151CCEBA224F4ADA6EBA8</idno><date when="2004" year="2004">2004</date><idno type="doi">10.1046/j.1540-8167.2004.04116.x</idno><idno type="url">https://api-v5.istex.fr/document/A3A0CC7C02F2B623ED4151CCEBA224F4ADA6EBA8/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000C29</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000C29</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Safety and Feasibility of Cryothermal Ablation Within the Mid‐ and Distal Coronary Sinus</title><author><name sortKey="Skanes, Allan C" sort="Skanes, Allan C" uniqKey="Skanes A" first="Allan C." last="Skanes">Allan C. Skanes</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation></author><author><name sortKey="Jones, Douglas L" sort="Jones, Douglas L" uniqKey="Jones D" first="Douglas L." last="Jones">Douglas L. Jones</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation><affiliation><mods:affiliation>Physiology and Pharmacology</mods:affiliation></affiliation></author><author><name sortKey="Teefy, Patrick" sort="Teefy, Patrick" uniqKey="Teefy P" first="Patrick" last="Teefy">Patrick Teefy</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation></author><author><name sortKey="Guiraudon, Colette" sort="Guiraudon, Colette" uniqKey="Guiraudon C" first="Colette" last="Guiraudon">Colette Guiraudon</name><affiliation><mods:affiliation>Pathology, University of Western Ontario, London, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Yee, Raymond" sort="Yee, Raymond" uniqKey="Yee R" first="Raymond" last="Yee">Raymond Yee</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation></author><author><name sortKey="Krahn, Andrew D" sort="Krahn, Andrew D" uniqKey="Krahn A" first="Andrew D." last="Krahn">Andrew D. Krahn</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation></author><author><name sortKey="Klein, George J" sort="Klein, George J" uniqKey="Klein G" first="George J." last="Klein">George J. Klein</name><affiliation><mods:affiliation>Medicine</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Cardiovascular Electrophysiology</title><idno type="ISSN">1045-3873</idno><idno type="eISSN">1540-8167</idno><imprint><publisher>Blackwell Science Inc</publisher><pubPlace>350 Main Street , Malden , MA 02148‐5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK .</pubPlace><date type="published" when="2004-11">2004-11</date><biblScope unit="volume">15</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1319">1319</biblScope><biblScope unit="page" to="1323">1323</biblScope></imprint><idno type="ISSN">1045-3873</idno></series><idno type="istex">A3A0CC7C02F2B623ED4151CCEBA224F4ADA6EBA8</idno><idno type="DOI">10.1046/j.1540-8167.2004.04116.x</idno><idno type="ArticleID">JCE04116</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1045-3873</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ablation</term><term>arrhythmia</term><term>cryothermy</term><term>tachycardia</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Introduction: The aim of this study was to assess the safety and feasibility of catheter‐based cryothermal ablation lesions in the mid‐ and distal coronary sinus. Methods and Results: Cryothermal ablation lesions were delivered using a 7‐French catheter at the mid‐ (n = 13) and distal (n = 12) coronary sinus in 14 swine under general anesthesia. Lesions were delivered for 2 or 4 minutes in a 1:2 randomized ratio such that seven 2‐minute lesions and eighteen 4‐minute lesions were delivered to a maximum negative temperature of −70°C. Integrity of the circumflex artery was assessed by angiography before and after each lesion application. In five animals, arterial Doppler flow velocity was continuously monitored and coronary flow reserve assessed. Histologic assessment of the left AV ring was made after a 48‐hour survival period and lesions graded for depth and transmurality. Eighteen of 25 lesions were >3 mm deep: five of seven 2‐minute lesions and thirteen of eighteen 4‐minute lesions. Lesions were transmural in 18 of 25 cases. Two transmural lesions were limited in depth due to their epicardial position. One 2‐minute mid‐coronary sinus lesion was not found. Adherent thrombus was seen grossly in the coronary sinus at one site and only on microscopic examination in three other lesions. Angiography demonstrated no arterial spasm or thrombosis. Continuous‐flow Doppler remained unchanged throughout lesion production. Coronary flow reserve was unchanged (1.7 ± 0.8 preablation vs 1.7 ± 1.0 postablation, P = 0.6). The media and intima were preserved in all cases. Necrosis of the adventitia was seen in one arterial segment. Conclusion: Catheter‐based cryoablation can produce lesions in the musculature of the adjacent atrium and ventricle when accessed from the coronary sinus without significant injury to the coronary sinus or adjacent artery. This method has potential application as the ablation method of choice when such lesions are required.</div></front></TEI><istex><corpusName>wiley</corpusName><author><json:item><name>ALLAN C. SKANES M.D.</name><affiliations><json:string>Medicine</json:string></affiliations></json:item><json:item><name>DOUGLAS L. JONES Ph.D.</name><affiliations><json:string>Medicine</json:string><json:string>Physiology and Pharmacology</json:string></affiliations></json:item><json:item><name>PATRICK TEEFY M.D.</name><affiliations><json:string>Medicine</json:string></affiliations></json:item><json:item><name>COLETTE GUIRAUDON M.D.</name><affiliations><json:string>Pathology, University of Western Ontario, London, Ontario, Canada</json:string></affiliations></json:item><json:item><name>RAYMOND YEE M.D.</name><affiliations><json:string>Medicine</json:string></affiliations></json:item><json:item><name>ANDREW D. KRAHN M.D.</name><affiliations><json:string>Medicine</json:string></affiliations></json:item><json:item><name>GEORGE J. KLEIN M.D.</name><affiliations><json:string>Medicine</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>arrhythmia</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ablation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cryothermy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>tachycardia</value></json:item></subject><articleId><json:string>JCE04116</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>Introduction: The aim of this study was to assess the safety and feasibility of catheter‐based cryothermal ablation lesions in the mid‐ and distal coronary sinus. Methods and Results: Cryothermal ablation lesions were delivered using a 7‐French catheter at the mid‐ (n = 13) and distal (n = 12) coronary sinus in 14 swine under general anesthesia. Lesions were delivered for 2 or 4 minutes in a 1:2 randomized ratio such that seven 2‐minute lesions and eighteen 4‐minute lesions were delivered to a maximum negative temperature of −70°C. Integrity of the circumflex artery was assessed by angiography before and after each lesion application. In five animals, arterial Doppler flow velocity was continuously monitored and coronary flow reserve assessed. Histologic assessment of the left AV ring was made after a 48‐hour survival period and lesions graded for depth and transmurality. Eighteen of 25 lesions were >3 mm deep: five of seven 2‐minute lesions and thirteen of eighteen 4‐minute lesions. Lesions were transmural in 18 of 25 cases. Two transmural lesions were limited in depth due to their epicardial position. One 2‐minute mid‐coronary sinus lesion was not found. Adherent thrombus was seen grossly in the coronary sinus at one site and only on microscopic examination in three other lesions. Angiography demonstrated no arterial spasm or thrombosis. Continuous‐flow Doppler remained unchanged throughout lesion production. Coronary flow reserve was unchanged (1.7 ± 0.8 preablation vs 1.7 ± 1.0 postablation, P = 0.6). The media and intima were preserved in all cases. Necrosis of the adventitia was seen in one arterial segment. Conclusion: Catheter‐based cryoablation can produce lesions in the musculature of the adjacent atrium and ventricle when accessed from the coronary sinus without significant injury to the coronary sinus or adjacent artery. This method has potential application as the ablation method of choice when such lesions are required.</abstract><qualityIndicators><score>5.677</score><pdfVersion>1.3</pdfVersion><pdfPageSize>594 x 783 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>1967</abstractCharCount><pdfWordCount>2677</pdfWordCount><pdfCharCount>16985</pdfCharCount><pdfPageCount>5</pdfPageCount><abstractWordCount>303</abstractWordCount></qualityIndicators><title>Safety and Feasibility of Cryothermal Ablation Within the Mid‐ and Distal Coronary Sinus</title><genre><json:string>article</json:string></genre><host><title>Journal of Cardiovascular 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Sinus</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Science Inc</publisher><pubPlace>350 Main Street , Malden , MA 02148‐5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK .</pubPlace><availability><p>WILEY</p></availability><date>2004</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Safety and Feasibility of Cryothermal Ablation Within the Mid‐ and Distal Coronary Sinus</title><author xml:id="author-1"><persName><forename type="first">ALLAN C.</forename><surname>SKANES</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Medicine</affiliation></author><author xml:id="author-2"><persName><forename type="first">DOUGLAS L.</forename><surname>JONES</surname></persName><roleName type="degree">Ph.D.</roleName><affiliation>Medicine</affiliation><affiliation>Physiology and Pharmacology</affiliation></author><author xml:id="author-3"><persName><forename type="first">PATRICK</forename><surname>TEEFY</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Medicine</affiliation></author><author xml:id="author-4"><persName><forename type="first">COLETTE</forename><surname>GUIRAUDON</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Pathology, University of Western Ontario, London, Ontario, Canada</affiliation></author><author xml:id="author-5"><persName><forename type="first">RAYMOND</forename><surname>YEE</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Medicine</affiliation></author><author xml:id="author-6"><persName><forename type="first">ANDREW D.</forename><surname>KRAHN</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Medicine</affiliation></author><author xml:id="author-7"><persName><forename type="first">GEORGE J.</forename><surname>KLEIN</surname></persName><roleName type="degree">M.D.</roleName><affiliation>Medicine</affiliation></author></analytic><monogr><title level="j">Journal of Cardiovascular Electrophysiology</title><idno type="pISSN">1045-3873</idno><idno type="eISSN">1540-8167</idno><idno type="DOI">10.1111/(ISSN)1540-8167</idno><imprint><publisher>Blackwell Science Inc</publisher><pubPlace>350 Main Street , Malden , MA 02148‐5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK .</pubPlace><date type="published" when="2004-11"></date><biblScope unit="volume">15</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="page" from="1319">1319</biblScope><biblScope unit="page" to="1323">1323</biblScope></imprint></monogr><idno type="istex">A3A0CC7C02F2B623ED4151CCEBA224F4ADA6EBA8</idno><idno type="DOI">10.1046/j.1540-8167.2004.04116.x</idno><idno type="ArticleID">JCE04116</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2004</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Introduction: The aim of this study was to assess the safety and feasibility of catheter‐based cryothermal ablation lesions in the mid‐ and distal coronary sinus. Methods and Results: Cryothermal ablation lesions were delivered using a 7‐French catheter at the mid‐ (n = 13) and distal (n = 12) coronary sinus in 14 swine under general anesthesia. Lesions were delivered for 2 or 4 minutes in a 1:2 randomized ratio such that seven 2‐minute lesions and eighteen 4‐minute lesions were delivered to a maximum negative temperature of −70°C. Integrity of the circumflex artery was assessed by angiography before and after each lesion application. In five animals, arterial Doppler flow velocity was continuously monitored and coronary flow reserve assessed. Histologic assessment of the left AV ring was made after a 48‐hour survival period and lesions graded for depth and transmurality. Eighteen of 25 lesions were >3 mm deep: five of seven 2‐minute lesions and thirteen of eighteen 4‐minute lesions. Lesions were transmural in 18 of 25 cases. Two transmural lesions were limited in depth due to their epicardial position. One 2‐minute mid‐coronary sinus lesion was not found. Adherent thrombus was seen grossly in the coronary sinus at one site and only on microscopic examination in three other lesions. Angiography demonstrated no arterial spasm or thrombosis. Continuous‐flow Doppler remained unchanged throughout lesion production. Coronary flow reserve was unchanged (1.7 ± 0.8 preablation vs 1.7 ± 1.0 postablation, P = 0.6). The media and intima were preserved in all cases. Necrosis of the adventitia was seen in one arterial segment. Conclusion: Catheter‐based cryoablation can produce lesions in the musculature of the adjacent atrium and ventricle when accessed from the coronary sinus without significant injury to the coronary sinus or adjacent artery. This method has potential application as the ablation method of choice when such lesions are required.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>keywords</head><item><term>arrhythmia</term></item><item><term>ablation</term></item><item><term>cryothermy</term></item><item><term>tachycardia</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2004-11">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api-v5.istex.fr/document/A3A0CC7C02F2B623ED4151CCEBA224F4ADA6EBA8/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Science Inc</publisherName><publisherLoc> 350 Main Street , Malden , MA 02148‐5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK . </publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1540-8167</doi><issn type="print">1045-3873</issn><issn type="electronic">1540-8167</issn><idGroup><id type="product" value="JCE"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY">Journal of Cardiovascular Electrophysiology</title></titleGroup></publicationMeta><publicationMeta level="part" position="11011"><doi origin="wiley">10.1111/jce.2004.15.issue-11</doi><numberingGroup><numbering type="journalVolume" number="15">15</numbering><numbering type="journalIssue" number="11">11</numbering></numberingGroup><coverDate startDate="2004-11">November 2004</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="17" status="forIssue"><doi origin="wiley">10.1046/j.1540-8167.2004.04116.x</doi><idGroup><id type="unit" value="JCE04116"></id><id type="supplier" value="jce04116"></id></idGroup><countGroup><count type="pageTotal" number="5"></count></countGroup><titleGroup><title type="tocHeading1">ORIGINAL ARTICLES
<i>Experimental</i></title></titleGroup><eventGroup><event type="firstOnline" date="2004-12-08"></event><event type="publishedOnlineFinalForm" date="2004-12-08"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.4 mode:FullText source:FullText result:FullText" date="2010-03-30"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-29"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-24"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="1319">1319</numbering><numbering type="pageLast" number="1323">1323</numbering></numberingGroup><correspondenceTo>Allan Skanes, M.D., Arrhythmia Service, London Health Sciences Centre, University Campus, 339 Windermere Road, London, Ontario, Canada N6A 5A5. Fax: 519‐434‐3278; E‐mail: <email>allan.skanes@lhsc.on.ca</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:JCE.JCE4116.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="5"></count><count type="tableTotal" number="1"></count><count type="formulaTotal" number="0"></count><count type="referenceTotal" number="17"></count><count type="linksCrossRef" number="31"></count></countGroup><titleGroup><title type="main">Safety and Feasibility of Cryothermal Ablation Within the Mid‐ and Distal Coronary Sinus</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>ALLAN C.</givenNames><familyName>SKANES</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a1 #a2"><personName><givenNames>DOUGLAS L.</givenNames><familyName>JONES</familyName><degrees>Ph.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a1"><personName><givenNames>PATRICK</givenNames><familyName>TEEFY</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a3"><personName><givenNames>COLETTE</givenNames><familyName>GUIRAUDON</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr5" affiliationRef="#a1"><personName><givenNames>RAYMOND</givenNames><familyName>YEE</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr6" affiliationRef="#a1"><personName><givenNames>ANDREW D.</givenNames><familyName>KRAHN</familyName><degrees>M.D.</degrees></personName></creator><creator creatorRole="author" xml:id="cr7" affiliationRef="#a1"><personName><givenNames>GEORGE J.</givenNames><familyName>KLEIN</familyName><degrees>M.D.</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="a1"><unparsedAffiliation>Medicine</unparsedAffiliation></affiliation><affiliation xml:id="a2"><unparsedAffiliation>Physiology and Pharmacology</unparsedAffiliation></affiliation><affiliation xml:id="a3" countryCode="CA"><unparsedAffiliation>Pathology, University of Western Ontario, London, Ontario, Canada</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1"><i>arrhythmia</i></keyword><keyword xml:id="k2"><i>ablation</i></keyword><keyword xml:id="k3"><i>cryothermy</i></keyword><keyword xml:id="k4"><i>tachycardia</i></keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><!-- Cryoablation in the Distal Coronary Sinus. 
<p> <i>Introduction:</i> The aim of this study was to assess the safety and feasibility of catheter‐based cryothermal ablation lesions in the mid‐ and distal coronary sinus.</p><p> <i>Methods and Results:</i> Cryothermal ablation lesions were delivered using a 7‐French catheter at the mid‐ (n = 13) and distal (n = 12) coronary sinus in 14 swine under general anesthesia. Lesions were delivered for 2 or 4 minutes in a 1:2 randomized ratio such that seven 2‐minute lesions and eighteen 4‐minute lesions were delivered to a maximum negative temperature of −70°C. Integrity of the circumflex artery was assessed by angiography before and after each lesion application. In five animals, arterial Doppler flow velocity was continuously monitored and coronary flow reserve assessed. Histologic assessment of the left AV ring was made after a 48‐hour survival period and lesions graded for depth and transmurality. Eighteen of 25 lesions were >3 mm deep: five of seven 2‐minute lesions and thirteen of eighteen 4‐minute lesions. Lesions were transmural in 18 of 25 cases. Two transmural lesions were limited in depth due to their epicardial position. One 2‐minute mid‐coronary sinus lesion was not found. Adherent thrombus was seen grossly in the coronary sinus at one site and only on microscopic examination in three other lesions. Angiography demonstrated no arterial spasm or thrombosis. Continuous‐flow Doppler remained unchanged throughout lesion production. Coronary flow reserve was unchanged (1.7 ± 0.8 preablation vs 1.7 ± 1.0 postablation, P = 0.6). The media and intima were preserved in all cases. Necrosis of the adventitia was seen in one arterial segment.</p><p> <i>Conclusion:</i> Catheter‐based cryoablation can produce lesions in the musculature of the adjacent atrium and ventricle when accessed from the coronary sinus without significant injury to the coronary sinus or adjacent artery. This method has potential application as the ablation method of choice when such lesions are required.</p><!-- (J Cardiovasc Electrophysiol, Vol. 15, pp. 1319-1323, November 2004)
</abstractGroup></contentMeta><noteGroup><note xml:id="n-fnt-1" numbered="no"><p>Manuscript received 15 March 2004; Revised manuscript received 18 May 2004; Accepted for publication 10 June 2004.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Safety and Feasibility of Cryothermal Ablation Within the Mid‐ and Distal Coronary Sinus</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Safety and Feasibility of Cryothermal Ablation Within the Mid‐ and Distal Coronary Sinus</title></titleInfo><name type="personal"><namePart type="given">ALLAN C.</namePart><namePart type="family">SKANES</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Medicine</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">DOUGLAS L.</namePart><namePart type="family">JONES</namePart><namePart type="termsOfAddress">Ph.D.</namePart><affiliation>Medicine</affiliation><affiliation>Physiology and Pharmacology</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">PATRICK</namePart><namePart type="family">TEEFY</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Medicine</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">COLETTE</namePart><namePart type="family">GUIRAUDON</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Pathology, University of Western Ontario, London, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">RAYMOND</namePart><namePart type="family">YEE</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Medicine</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">ANDREW D.</namePart><namePart type="family">KRAHN</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Medicine</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">GEORGE J.</namePart><namePart type="family">KLEIN</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Medicine</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>Blackwell Science Inc</publisher><place><placeTerm type="text">350 Main Street , Malden , MA 02148‐5018 , USA , and 9600 Garsington Road , Oxford OX4 2DQ , UK .</placeTerm></place><dateIssued encoding="w3cdtf">2004-11</dateIssued><copyrightDate encoding="w3cdtf">2004</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">5</extent><extent unit="tables">1</extent><extent unit="references">17</extent></physicalDescription><abstract lang="en">Introduction: The aim of this study was to assess the safety and feasibility of catheter‐based cryothermal ablation lesions in the mid‐ and distal coronary sinus. Methods and Results: Cryothermal ablation lesions were delivered using a 7‐French catheter at the mid‐ (n = 13) and distal (n = 12) coronary sinus in 14 swine under general anesthesia. Lesions were delivered for 2 or 4 minutes in a 1:2 randomized ratio such that seven 2‐minute lesions and eighteen 4‐minute lesions were delivered to a maximum negative temperature of −70°C. Integrity of the circumflex artery was assessed by angiography before and after each lesion application. In five animals, arterial Doppler flow velocity was continuously monitored and coronary flow reserve assessed. Histologic assessment of the left AV ring was made after a 48‐hour survival period and lesions graded for depth and transmurality. Eighteen of 25 lesions were >3 mm deep: five of seven 2‐minute lesions and thirteen of eighteen 4‐minute lesions. Lesions were transmural in 18 of 25 cases. Two transmural lesions were limited in depth due to their epicardial position. One 2‐minute mid‐coronary sinus lesion was not found. Adherent thrombus was seen grossly in the coronary sinus at one site and only on microscopic examination in three other lesions. Angiography demonstrated no arterial spasm or thrombosis. Continuous‐flow Doppler remained unchanged throughout lesion production. Coronary flow reserve was unchanged (1.7 ± 0.8 preablation vs 1.7 ± 1.0 postablation, P = 0.6). The media and intima were preserved in all cases. Necrosis of the adventitia was seen in one arterial segment. Conclusion: Catheter‐based cryoablation can produce lesions in the musculature of the adjacent atrium and ventricle when accessed from the coronary sinus without significant injury to the coronary sinus or adjacent artery. This method has potential application as the ablation method of choice when such lesions are required.</abstract><subject lang="en"><genre>keywords</genre><topic>arrhythmia</topic><topic>ablation</topic><topic>cryothermy</topic><topic>tachycardia</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Cardiovascular Electrophysiology</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1045-3873</identifier><identifier type="eISSN">1540-8167</identifier><identifier type="DOI">10.1111/(ISSN)1540-8167</identifier><identifier type="PublisherID">JCE</identifier><part><date>2004</date><detail type="volume"><caption>vol.</caption><number>15</number></detail><detail type="issue"><caption>no.</caption><number>11</number></detail><extent unit="pages"><start>1319</start><end>1323</end><total>5</total></extent></part></relatedItem><identifier type="istex">A3A0CC7C02F2B623ED4151CCEBA224F4ADA6EBA8</identifier><identifier type="DOI">10.1046/j.1540-8167.2004.04116.x</identifier><identifier type="ArticleID">JCE04116</identifier><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>Blackwell Science Inc</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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