Impact of Freezing Time and Balloon Size on the Thermodynamics and Isolation Efficacy during Pulmonary Vein Isolation Using the Second Generation Cryoballoon

Abstract

Background - The differences in ablation characteristics of freezing time and balloon size using second generation cryoballoon are still unknown. Methods and Results - Twenty-six dogs underwent pulmonary vein (PV) isolation. Balloon and tissue temperatures (left atrial-PV junction, phrenic nerve, and internal esophagus) were monitored. The ablation duration was randomized to either 3 or 4 minutes, which did not show significant differences in temperature profiles, PV isolation success rate, complications, or histological changes. Twenty dogs underwent cryoablation using 28-mm cryoballoon, 6 dogs were done using the 23-mm cryoballoon. Positioning of the 23-mm cryoballoon was more distal in the PV, which resulted in better PV occlusion. Temperature profiles showed lower temperatures in the 23-mm cryoballoon than in the 28-mm cryoballoon (inner balloon, median [range]: -51.5 [-66.0 to -31.0] versus -43.0 [-64.0 to -26.0]°C, P<0.001; balloon surface: -43.0 [-60.0 to -15.8] versus -6.5 [-46.2 to 28.9]°C, P<0.001; left atrial-PV junction: -6.7 [-20.0 to 21.4] versus 15.8 [-14.4 to 35.1]°C, P<0.001), and trended toward a higher PV isolation success rate in the 23-mm cryoballoon. Histologically, deeper extensions of ablative lesions into the PV were seen with 23-mm cryoballoon, and larger ablative lesions were seen in the left atrial antrum using 28-mm cryoballoon. Conclusions - The efficacy of 3-minute ablation was not significantly different from 4-minute ablation in dogs. The 23-mm cryoballoon had a greater cooling effect than the 28-mm cryoballoon for small PVs, but showed narrower ablative lesions in the left atrial antrum.