Key result
Cryoablation reduces acute edema volume ~34% vs. RFA for similar chronic lesion sizes.
Why the study?
The extent and time course of edema associated with radiofrequency and cryoablation for arrhythmias is unknown.
Absolute Event Rate: 1225% vs 1855.2%
p-value: p=0.01
Smaller acute edema with cryoablation may affect imaging interpretation; leaves open clinical translation and human outcome impact.
Introduction Radiofrequency (RF) and cryoablation are routinely used to treat arrhythmias, but the extent and time course of edema associated with the two different modalities is unknown. Our goal was to follow the lesion maturation and edema formation after RF and cryoablation using serial magnetic resonance imaging (MRI). Methods and Results Ventricular ablation was performed in a canine model ( n = 11) using a cryo or an irrigated RF catheter. T2‐weighted (T2w) edema imaging and late gadolinium enhancement (LGE)‐MRI were done immediately (0 day: acute), 1 to 2 weeks (subacute), and 8 to 12 weeks (chronic) after ablation. After the final MRI, excised hearts underwent pathological evaluation. As a result, 45 ventricular lesions (cryo group: 20; RF group: 25) were evaluated. Acute LGE volume was not significantly different but acute edema volume in cryo group was significantly smaller (1225.0 ± 263.5 vs 1855.2 ± 520.5 mm 3 ; P = 0.01). One week after ablation, edema still existed in both group but was similar in size. Two weeks after ablation there was no edema in either of the groups. In the chronic phase, the lesion volume for cryo and RF in LGE‐MRI (296.7 ± 156.4 vs 281.6 ± 140.8 mm 3 ; P = 0.73); and pathology (243.3 ± 125.9 vs 214.5 ± 148.6 mm 3 ; P = 0.49), as well as depth, was comparable. Conclusions When comparing cryo and RF lesions of similar chronic size, acute edema is larger for RF lesions. Edema resolves in both cryo and RF lesions in 1 to 2 weeks.
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Yamashita et al. (2018) studied Ventricular ablation lesions (n=11). Cryoablation vs. Radiofrequency (RF) ablation was evaluated on Acute edema volume (mm3) (p=0.01). Acute edema volume was significantly smaller following cryoablation compared to radiofrequency ablation (1225.0 vs 1855.2 mm3; P=0.01) when comparing lesions of similar chronic size.