Auswirkung von drei konsekutiven Kryoenergieapplikationen auf die Bildung und Größe von Ablationsläsionen und die Koronararterien im sich entwickelnden Myokard

Effects of triple cryoenergy application on lesion formation and coronary arteries in the developing myocardium

by Filipe Abreu da Cunha
Doctoral thesis
Date of Examination:2020-10-27
Date of issue:2020-10-14
Advisor:PD Dr. Ulrich Krause
Referee:PD Dr. Ulrich Krause
Referee:Prof. Dr. Markus Zabel
Referee:Prof. Dr. Martin Oppermann
Persistent Address: http://dx.doi.org/10.53846/goediss-8249

 

 

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Abstract

English

Aims: To improve long-term outcome after cryoablation of SVT substrates, application of two and three consecutive freeze-thaw cycles has been performed. The effect of triple freeze-thaw cycles on lesion formation within developing myocardium and coronary arteries, however, has not been studied yet. Methods: In 8 piglets (mean age 15 weeks, weight 15-20 kg), a total of 30 cryolesions (three consecutive freeze-thaw cycles) were applied to the atrial aspect of both AV valve annuli (n=18) as well as to ventricular myocardium below the valves (n=12). Coronary angiography was performed before and after cryoenergy application. The animals were reevaluated by coronary angiography and intracoronary ultrasound after 48 hours. All hearts were removed for histological examination of the lesions subsequently. After staining (hematoxylin-eosin, desmin immunohistochemstry) lesions was measured by planimetry with a digital virtual miscroscope analysis system and volumes of the cryo-lesions were calculated. Results: Mean atrial lesion volume was 190.68 ± 167.53 mm3 (n=18) and mean ventricular lesion volume was 184.34 ± 107.42 mm3 (n=12). Compared with previously reported data on lesion volumes after single and double freeze-thaw cycles, lesions were significantly larger. Coronary arteries were unaffected on coronary angiography as well as on ICUS. No affection of coronary arteries was found on histological examination. Conclusion: Application of three consecutive freeze-thaw cycles resulted in increased lesion volume compared with single and double freeze-thaw cycles. No affection of the coronary arteries was evident. To evaluate the clinical benefit and safety of triple cryoenergy application for catheter ablation prospective randomized trials are required.
Keywords: cryoenergy; catheter ablation; supraventricular tachycardia; developing myocardium; coronary artery
 
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