The intracardiac echocardiographic findings during rewarming using catheter-based cryoablation

Abstract Introduction Cryoablation unlike radiofrequency ablation (RFA) does not damage the endothelium and lining and causes less physical damage, and the mechanisms remain unclear. The increased myocardial echogenicity (iME) observed by intracardiac echocardiography (ICE) during RFA has been reported as the ablation indicator. Purpose To evaluate the ICE findings during ablation using catheter-based cryoablation. Methods In an extra vivo experiment, we set the bovine myocardium to 36°C in a constant temperature bath and experimented on a water tank that generated a non-pulsatile flow. Catheter-based cryoablation was applied to the bovine myocardium at -80 degrees for 240 seconds. The ICE images were evaluated using ViewFlex Xtra during catheter-based cryoablation. Results Macroscopic change (Figure 1): Four seconds after the start of cooling, a thin film of ice began to form between the myocardium and the catheter, and after 7 seconds, the tip of the catheter was covered with ice and the surface of the myocardium was covered with ice. After that, it grew rapidly and an ice ball was formed. There was no change after 18 seconds of cooling. ICE findings (Figure 2): 4 seconds after cooling started, the ME around the catheter tip began to increase, and the ME gradually increased with flickering. The iME stopped after cooling down for 18 seconds and did not change after that. Immediately after stopping cooling, severe flickering occurred and the area of iME began to shrink. The ME gradually returned to its original state with slight bubbles from the central ablation site. Macroscopic change and ICE findings were reproducibly confirmed. Myocardial findings after ablation: The area of cooling was discernible, but the color difference from the surrounding area was not obvious. Conclusions The catheter-based cryoablation ablation shows the severest change detected by ICE immediately after stopping cooling. In addition to tissue damage during the freezing stage, the rewarming may be more associated with tissue damage.