The cryogens employed in current cryosurgical devices are almost exclusively a gas, typically argon, undergoing Joule–Thomson (JT) cooling. These devices utilize small diameter probes with near instantaneous ice generation. The effective cryoablation zone, however, is small thus requiring multiple probes and/or multiple freeze and extended freeze application intervals to provide a given size cryolesion. In contrast, liquid nitrogen systems provide high levels of heat extraction with low nadir temperatures, but given its boiling point (−197 °C) and ratio of thermal expansion, probe sizes are often larger and procedure durations longer. Recently, we have developed a novel cryosurgical platform utilizing nitrogen in the super critical state (SCN). In this study, we conducted a quantitative comparison of the performance of the SCN system to that of a JT device. Evaluation of the isothermal gradient generated during the freeze procedure was assessed with thermocouple arrays in various tissue approximations such as water, ultrasound gel, and porcine muscle sections. Additionally, a series of feasibility in vivo studies were conducted to assess the performance of the SCN system for endocardial and epicardial ablation applications in a canine model. The data revealed that the SCN system created significantly colder nadir temperatures (−170 °C as compared to −140 °C) and broader spread of critical isotherms compared to that of the JT system. Further, it was found that the SCN generated this larger and colder iceball in approximately half the time. In a comparison of surface freezing in an ex vivo porcine tissue model (5–10 mm thick muscle) under thermal load to model epicardial cardiac ablation, it was found that the SCN platform created transmural lesions that were colder and narrower than that created by JT devices. In vivo endocardial cardiac ablation canine studies revealed that the SCN system was capable of generating transmural lesions with complete electrical block in fully beating heart in ⩽60 s. The results of these studies demonstrated the SCN system provides for rapid, effective, controllable freezing of targeted tissue. The use of the SCN system allowed for the miniaturization and speed of JT devices, yet maintains the ultra cold nadir temperatures and cooling potential of a liquid nitrogen system. The power, speed and freeze characteristics of the SCN system offers the potential of a reduction in procedural time compared to current cryo devices. Further, these technological developments may open new avenues for the application of cryo to treat other cardiac arrhythmogenic disorders.
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