Journal
JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY
Volume 21, Issue 3, Pages 187-193Publisher
SPRINGER
DOI: 10.1007/s10840-008-9205-6
Keywords
Cryolesion; Ablation; Bachmann's bundle; Coronary sinus; Atrial fibrillation; Pulmonary vein
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We previously published encircling endocardial cryo-isolation of the pulmonary vein (PV) region. This study documented mechanisms of isolation failure using CARTO (R) mapping. Cryo-isolation used a modified Surgifrost (R) introduced via a Universal Cardiac Introducer (R) on the left atrial appendage. Of five pigs, two had incomplete isolation and repeat mapping: Activation was over Bachmann's bundle (BB) in one and the coronary sinus (CS) in the other. Repeat cryoablation failed to eliminate gaps. Histologically, the BB gap had nonlesioned sub-epicardial fibres and thick fat covering the cryolesioned BB: fat protecting the epicardium from cryoablation. The inferior gap had a large CS, and a thick myocardium bridging the isthmus: myocardial thickness and CS thermal sink preventing transmural cryolesions. CARTO (R) mapping localized gaps. Although the CS is known to cause failure, its protective mechanism is not well documented. The BB gap is novel. These findings have important clinical implications for isolation of the PV region.
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