Novel case of linear ultra-low cryoablation catheter for treatment of ventricular tachycardia

Figures

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  Figure 1. The ultra-low-temperature cryoablation system (Adagio Medical, Laguna Hills, CA). A: Cryoablation console. B: Ventricular tachycardia (VT) catheter, before freezing. C: VT catheter with the ice ball forming on cryoablation element. D: Ventricular lesion depth as a function of freeze time using first freeze—1-minute thaw—second freeze cryoablation cycle. (Courtesy Adagio Medical, Inc. CS-098.)

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  Figure 2. Bipolar voltage maps performed in sinus rhythm using a multipolar mapping catheter and electroanatomic mapping system (HD Grid, EnSite Precision; Abbott, Minneapolis, MN). Baseline voltage maps are shown on the left side where gray regions represent dense scar with voltage <0.5 mV, purple regions represent voltage >1.5 mV, and other color regions represent scar border zones (0.5–1.5 mV). The right-side images show the cryoablation lesions applied. The size of the lesions depicted is based on the calculated size shown in preclinical models. The lower panel shows the abolition of signals from the targeted region.

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  Figure 3. Fluoroscopic, intracardiac echocardiographic (ICE), and electroanatomic depictions of the ultra-low-temperature cryoablation catheter (Adagio Medical, Laguna Hills, CA). On the left side of the upper images, fluoroscopy shows the dark 15 mm tip of the ablation catheter. In the middle upper panel, the tip of the catheter is seen on ICE (arrow). The lesion has a ring-enhancing border with low echogenicity in the center (circle). Ice formation on the catheter tip is not easily seen on ICE. On the right upper panel, the catheter is shown on the mapping system. In the lower left panel, the catheter is flexed into a semicircular shape to get good contact with the anterobasal wall. The curved catheter is seen on the ICE image to the right. The ICE images are inverted vertically since the imaging catheter is retroflexed in the right ventricle.