Ultra-Low Temperature Cryoablation for Ventricular Tachycardia: An Early Single Centre Report of Acute Results

BackgroundEndocardial catheter ablation for ventricular tachycardia (VT) may fail owing to the inability to deliver transmural lesions. Ultra-low temperature cryoablation (ULTC) uses near-critical nitrogen and can generate temperatures as low as −196°C. We report a series of 18 patients that underwent ULTC at the McGill University Health Centre (MUHC), representing the largest single center experience to date.MethodsEighteen patients with monomorphic drug-refractory VT underwent VT ablation with ULTC at our institution as part of the first-in-human CryoCure-VT trial (NCT04893317). After voltage map, the mapping catheter was replaced with the ULTC catheter and lesions were applied over a fixed duration of time (60–180 s), followed by a 60-second thaw and another application at the original duration (freeze-thaw-freeze). Duration of ablation time was selected depending on the wall thickness of the left ventricle monitored with intracardiac echo to achieve tissue depths of 4.5–7.5 mm.ResultsBaseline left ventricular ejection fraction was 32%, mean age 71 years, 94% were male. A total of 32 sustained VTs were induced in 16 of 18 patients. A total of 177 cryoablation lesions were delivered (9.8 lesions per patient). Of the 16 patients with inducible VT, 15 (94%) were rendered non-inducible post ablation and 1 was inducible only for a non-clinical VT. Complications included 1 pericardial effusion that required drainage. From 18 patients, 16 (89%) were discharged within the first 24 hours post ablation.ConclusionsULTC is feasible and permits acute control of monomorphic VT during VT ablation procedures in drug-refractory patients. Endocardial catheter ablation for ventricular tachycardia (VT) may fail owing to the inability to deliver transmural lesions. Ultra-low temperature cryoablation (ULTC) uses near-critical nitrogen and can generate temperatures as low as −196°C. We report a series of 18 patients that underwent ULTC at the McGill University Health Centre (MUHC), representing the largest single center experience to date. Eighteen patients with monomorphic drug-refractory VT underwent VT ablation with ULTC at our institution as part of the first-in-human CryoCure-VT trial (NCT04893317). After voltage map, the mapping catheter was replaced with the ULTC catheter and lesions were applied over a fixed duration of time (60–180 s), followed by a 60-second thaw and another application at the original duration (freeze-thaw-freeze). Duration of ablation time was selected depending on the wall thickness of the left ventricle monitored with intracardiac echo to achieve tissue depths of 4.5–7.5 mm. Baseline left ventricular ejection fraction was 32%, mean age 71 years, 94% were male. A total of 32 sustained VTs were induced in 16 of 18 patients. A total of 177 cryoablation lesions were delivered (9.8 lesions per patient). Of the 16 patients with inducible VT, 15 (94%) were rendered non-inducible post ablation and 1 was inducible only for a non-clinical VT. Complications included 1 pericardial effusion that required drainage. From 18 patients, 16 (89%) were discharged within the first 24 hours post ablation. ULTC is feasible and permits acute control of monomorphic VT during VT ablation procedures in drug-refractory patients.