TY - JOUR
T1 - Cryosurgery for cardiac arrhythmias
T2 - Acute and chronic effects on coronary arteries
AU - Holman, William L.
AU - Ikeshita, Masatoshi
AU - Ungerleider, Ross M.
AU - Smith, Peter K.
AU - Ideker, Raymond E.
AU - Cox, James Lewis
N1 - Funding Information:
Cryothermic ablation of myocardium has been advocated in a variety of surgical procedures for the management of both supraventricular and ventricular arrhythmias. Some of these procedures require the application of cryothermia in the vicinity of major coronary vessels . For example, the experimental left atrial isolation procedure' as well as cryothermic ablation of aberrant pathways of atrioventricular conduction 2 requires the use of cryothermia in the atrioventricular groove . In addition, cryothermic ablation of arrhyth-Inogenic ventricular foci 3 . 4 may require exposure of From the Departments of Surgery, Medicine and Pathology, Duke University Medical Center, Durham, North Carolina . This study was supported in part by Grants HL 25983 and HL 06120 from the National Heart, Lung, and Blood Institute, the National Institutes of Health, Bethesda, Maryland . Manuscript received March 22, 1982 ; revised manuscript received June 22, 1982, accepted June 25, 1982 .
PY - 1983/1/1
Y1 - 1983/1/1
N2 - The use of cryosurgery near major coronary arteries for the treatment of supraventricular and ventricular tachyarrhythmias has caused concern over the possible deleterious acute and chronic effects of cryothermia on vessel patency and integrity. The present study was designed to examine both the acute and chronic effects of cryothermia on major coronary vessels in an experimental model that simulates clinical conditions. In the acute phase of the study, 10 dogs underwent direct cryothermic exposure of the left anterior descending (LAD) coronary artery while coronary artery flow and regional myocardial blood flow were calculated. Direct cryothermic exposure of the LAD resulted in total cessation of LAD blood flow 20 ± 4 seconds after institution of cryothermia. Arterial patency returned 29 ± 8 seconds after termination of cryothermic exposure. In the second phase of this study, 16 dogs had cryolesions applied directly over the LAD at myocardial temperatures of 37°C and during elective cardioplegic arrest at myocardial temperatures of 6 to 12°C. In addition, cryothermia was applied directly to the coronary sinus in these animals. The animals were allowed to live either 48 hours, 2 weeks, or 6 months after the initial procedure, and the cryolesions and underlying vessels were examined histologically. Although coronary arteriography at 6 months showed all coronary arteries to be patent, microscopic examination revealed coronary intimal hyperplasia to be present in the majority of the coronary arteries at the site of the cryolesion, particularly if the cryolesion had been applied during hypothermic, cardioplegic arrest. Cryothermia had no effect on the coronary sinus. This study provides evidence for cryothermia-induced coronary arterial damage that may produce hemodynamically significant coronary artery stenosis and suggests that caution be exercised when it is necessary to create cryolesions in the vicinity of major coronary arteries.
AB - The use of cryosurgery near major coronary arteries for the treatment of supraventricular and ventricular tachyarrhythmias has caused concern over the possible deleterious acute and chronic effects of cryothermia on vessel patency and integrity. The present study was designed to examine both the acute and chronic effects of cryothermia on major coronary vessels in an experimental model that simulates clinical conditions. In the acute phase of the study, 10 dogs underwent direct cryothermic exposure of the left anterior descending (LAD) coronary artery while coronary artery flow and regional myocardial blood flow were calculated. Direct cryothermic exposure of the LAD resulted in total cessation of LAD blood flow 20 ± 4 seconds after institution of cryothermia. Arterial patency returned 29 ± 8 seconds after termination of cryothermic exposure. In the second phase of this study, 16 dogs had cryolesions applied directly over the LAD at myocardial temperatures of 37°C and during elective cardioplegic arrest at myocardial temperatures of 6 to 12°C. In addition, cryothermia was applied directly to the coronary sinus in these animals. The animals were allowed to live either 48 hours, 2 weeks, or 6 months after the initial procedure, and the cryolesions and underlying vessels were examined histologically. Although coronary arteriography at 6 months showed all coronary arteries to be patent, microscopic examination revealed coronary intimal hyperplasia to be present in the majority of the coronary arteries at the site of the cryolesion, particularly if the cryolesion had been applied during hypothermic, cardioplegic arrest. Cryothermia had no effect on the coronary sinus. This study provides evidence for cryothermia-induced coronary arterial damage that may produce hemodynamically significant coronary artery stenosis and suggests that caution be exercised when it is necessary to create cryolesions in the vicinity of major coronary arteries.
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U2 - 10.1016/S0002-9149(83)80026-5
DO - 10.1016/S0002-9149(83)80026-5
M3 - Article
C2 - 6849254
AN - SCOPUS:0020675915
SN - 0002-9149
VL - 51
SP - 149
EP - 155
JO - The American journal of cardiology
JF - The American journal of cardiology
IS - 1
ER -