JACC: Clinical Electrophysiology
Termination of Atrial Fibrillation With Epicardial Cooling in the Oblique Sinus
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Author + information
- Chance M. Witt, MDa,
- Sean Dalton, BSb,
- Samuel O’Neil, BSc,
- Charles A. Ritrivi, MSb,
- Rich Sanders, MSb,
- Arjun Sharma, MDd,
- Greg Seifert, MSe,
- Steve Berhow, BSc,
- Doug Beinborn, MAf,
- Allan Witz, JDb,
- Trevor McCaw, MBAb,
- Christopher G. Scott, MSg,
- Deepak Padmanabhan, MBBSa,
- Ammar M. Killu, MBBSa,
- Niyada Naksuk, MDa,
- Samuel J. Asirvatham, MDa and
- Paul A. Friedman, MDa,∗ (friedman.paul{at}mayo.edu)
- aDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- bMedicool Technologies, Inc., Rochester, Minnesota
- cBiomerics, Rogers, Minnesota
- dMedical Device Consultants, LLC., St. Paul, Minnesota
- eAdvanced Medical Electronics Corporation, Maple Grove, Minnesota
- fVizient, Inc., Irving, Texas
- gDepartment of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Paul A. Friedman, Department of Cardiovascular Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, Minnesota 55905.
Graphical abstract
Abstract
Objectives This study aimed to determine if epicardial cooling could repeatedly terminate induced atrial fibrillation (AF) in a canine heart.
Background Rapid termination of AF could control symptoms and prevent atrial remodeling; however, defibrillation by internal electrical cardioversion is not tolerable to most patients. Cooling of the epicardium slows atrial conduction and may provide a less painful method to quickly terminate AF.
Methods AF was induced with atrial myocardial epinephrine injections and rapid atrial pacing in an open-chest canine. Attempts at termination were performed with a small metal device that was either cooled to 5°C or kept at body temperature (control module). The device was placed on the epicardial surface in the oblique sinus. The time from device contact to termination of AF was recorded.
Results In 5 different canine studies, there were 57 attempts at AF termination with either a 5°C module (34 attempts) or a control module (23 attempts). The median (interquartile range [IQR]) time to AF termination was 24 s (IQR: 15 to 35 s) for the 5°C therapy and 100 s (IQR: 47 to 240 s) for the body temperature treatments (p < 0.001). In the control group, there were 8 AF episodes that continued up to 4 min. Subsequent application of the 5°C cooling module terminated AF in all cases.
Conclusions Epicardial cooling in the oblique sinus is effective for repeated termination of AF in a canine heart. If reproduced in human studies, epicardial cooling with an implantable device may provide a method for management of patients with AF.
Footnotes
This material is based upon work supported by the National Science Foundation under Grant No. 1758602.
Mr. Sanders holds stock in Medicool Technologies. Dr. Sharma has been a consultant for Cardialen, Cyberheart, and VivaQuant, and holds stock in Boston Scientific. Drs. Friedman and Asirvatham hold intellectual property related to the Peltier cooling device. Mr. McCaw has equity in Medicool Technologies, Inc. Dr. Friedman holds equity ownership of Medicool Technologies. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received January 25, 2018.
- Revision received June 3, 2018.
- Accepted June 14, 2018.
- 2018 American College of Cardiology Foundation
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