title: New cryotechnology for electrical isolation of the pulmonary veins.
abstract: BACKGROUND
  Creation of radiofrequency lesions to isolate the pulmonary veins (PV) and ablate atrial fibrillation (AF) has been complicated by stenosis of the PVs. We tested a cryoballoon technology that can create electrical isolation of the PVs, with the hypothesis that cryoenergy will not result in PV stenosis.
  
  
  RESULTS
  Lesions were created in 9 dogs (weight 31-37 kg). Cryoenergy was applied to the PV-left atrial (LA) interface. Data collected before and after ablation included PV orifice size, arrhythmia inducibility, electrogram activity, and pacing threshold in the PVs. Tissue examination was performed immediately after ablation in 3 dogs and after 3 months (4.8 +/- 1.0) in 6 dogs. After ablation there was no localized P wave activity in the ablation zone and no LA-PV conduction. Before ablation, the pacing threshold was 1.9 +/- 1.1 mA in each PV. After ablation, the pacing threshold increased significantly to 7.2 +/- 1.8 mA, or capture was not possible. Burst pacing did not induce any sustained arrhythmias. Most dogs had hemoptysis during the first 24 to 48 hours. Acute tissue examination revealed hemorrhagic injury of the atrial-PV junction that extended into the lung parenchyma. After recovery, the lesions were circumferential and soft with no PV stenosis. Histologic examination revealed fibrous tissue with no PV-LA interface thickening.
  
  
  CONCLUSIONS
  This new cryoballoon technology effectively isolates the PVs from LA tissue. No PV stenosis was noted. Acute tissue hemorrhage and hemoptysis are short-term complications of this procedure. After 3 months of recovery, cryoablated tissue exhibits no collagen or cartilage formation.
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, Illinois 60612, USA. bavitall@uic.edu
authors.forename: Boaz
authors.initials: B
authors.lastname: Avitall
authors.forename: Dalia
authors.initials: D
authors.lastname: Urboniene
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Rozmus
authors.forename: Dan
authors.initials: D
authors.lastname: Lafontaine
authors.forename: Ray
authors.initials: R
authors.lastname: Helms
authors.forename: Arvydas
authors.initials: A
authors.lastname: Urbonas
mesh_terms: D000818:Animals; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003452:Cryosurgery; D004285:Dogs; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology*; D011859:Radiography; D014463:Ultrasonography