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Novel Cryoablation Method For Epicardial Surgical Ablation Of Ventricular Tachycardia On The Beating Heart
Grzegorz Wroblewski1, Mariusz Kowalewski2, Sebastian Stec3, Michal Pasierski2, Natalia Ogorzelec2, Anna Chomentowska2, Piotr Suwalski2.
1Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, Warsaw, Poland, 2Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland, 3Subcarpathian Center for Cardiovascular Intervention, Sanok, Poland.
BACKGROUND:Electrical storm with refractory ventricular tachycardia remains a life-threatening condition despite intensive pharmacotherapy and catheter-based ablation. In hemodynamically unstable patients, definitive arrhythmia control may require a surgical, beating-heart approach under mechanical circulatory support. However, conventional surgical cryoablation systems using argon or nitrous oxide may provide insufficient cooling on the perfused ventricular surface. Liquid nitrogen-based cryoablation offers greater freezing capacity, potentially enabling effective epicardial substrate modification on the beating heart when combined with intraoperative high-density electrophysiological mapping.
METHODS:Patients in life-threatening condition with refractory ventricular tachycardia and electrical storm were admitted on an emergency basis. All patients received perioperative veno-arterial extracorporeal membrane oxygenation support due to hemodynamic instability. Minimally invasive access via a left anterior minithoracotomy was used to reach the ventricular surface. The arrhythmogenic substrate was localized by intraoperative electrophysiological mapping with a high-density grid catheter. Cryoablation using a liquid nitrogen-based device was then performed epicardially on the beating heart. Patients underwent regular follow-up visits at 3 and 6 months postoperatively.
RESULTS:Three patients underwent surgery under compassionate use, after obtaining approval from the national regulatory authority and informed patient consent. All patients restored sinus rhythm after 2-8 cryoablation applications, each lasting 100-120 seconds. Intraoperative electrophysiological mapping after ablation revealed no residual electrical abnormalities, and pacing failed to induce ventricular tachycardia. The postoperative course was uneventful. All patients were discharged in sinus rhythm on postoperative day 3 for further treatment and rehabilitation. During follow-up (ongoing), all patients remain in good clinical condition with no recurrence of ventricular tachycardia.
CONCLUSIONS:This initial experience represents the first reported uses of a liquid nitrogen-based surgical cryoablation device during a beating-heart procedure. These cases demonstrate promising feasibility and outcomes of epicardial cryoablation for ventricular arrhythmia; however, further studies on a larger scale are required to assess the long-term efficacy and safety of this technique.
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