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. 2025 Feb 4;6(4):444-449.
doi: 10.1016/j.hroo.2025.01.017. eCollection 2025 Apr.

Termination of perioperative atrial fibrillation with epicardial cooling in the oblique sinus: A first-in-human feasibility study

Alejandro Trainini  1 , Miragaya Nicolàs  1 , Crespo Fabián  1 , Delgado Elìas Lorena  1 , Heredia Florencia  1 , Miranda Hernán  1 , Brodaric María Magdalena  1 , Ciscato Julio  1 , Adetola Ladejobi  2 , Ammar Killu  3 , Juan Crestanello  4 , Jason Tri  5 , Jeff Rynbrandt  6 , Samuel Asirvatham  3 , Paul Friedman  3 , Benjamin Elencwajg  1
Affiliations

Termination of perioperative atrial fibrillation with epicardial cooling in the oblique sinus: A first-in-human feasibility study

Alejandro Trainini et al. Heart Rhythm O2. .

Abstract

Background: Postoperative atrial fibrillation (AF) is associated with prolonged hospitalization, stroke and expense. We have previously demonstrated the effectiveness of cooling the oblique sinus to terminate AF in animal models.

Objective: The study sought to determine whether cooling can terminate intraoperative AF in humans undergoing cardiac surgery.

Methods: Patients presenting for clinically indicated cardiac surgery with a history of atrial fibrillation were enrolled. During surgery, before bypass, AF was induced if not present, and a 1 × 1 inch cooling device was placed in the oblique sinus that cooled to 5 to 10 °C at the device-tissue interface. Due to the pandemic, remote, real-time monitoring was used.

Results: Four patients (all women, mean age 69.3 years) underwent 8 AF inductions. Five (63%) of 8 episodes were terminated with cooling, with average time to termination (after 30 seconds of sustained arrhythmia) of 21 seconds. Of the 3 failed episodes, 1 may have been a type II termination, 1 organized to flutter, and 1 failed to cool for technical reasons. There were no procedure-related complications.

Conclusion: Termination of perioperative atrial fibrillation with epicardial cooling in the oblique sinus is feasible and appears safe in this very early first-in-human study.

Keywords: Epicardial cooling; First-in-human feasibility study; Oblique sinus; Postoperative atrial fibrillation; Stroke.

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Figures

Figure 1
Figure 1
Anatomic location of cooling and surgical placement. (Left) Anatomical depiction of the oblique sinus. The pericardium is shown with the anterior section and heart removed. The region to which cooling was applied is shown with the blue oval labelled “Cool.” (Right) Surgical placement of the device in the oblique sinus in one of the patients in the study. Note that the right panel is a captured image from a live, remote transmission, accounting for blurriness. IAR = inferior aortic recess; LPVR = left pulmonary vein recess; PVR = pulmonary vein recess; RPVR = right pulmonary vein recess;
Figure 2
Figure 2
Equipment used to cool the oblique sinus during cardiac surgery. (Left) Chiller kept at bedside that cooled saline and pumped it through the system to maintain a specified temperature at the posterior left atrium. (Middle) Close-up of the cooling element through which saline circulated. (Right) View of the cooling elements with tubing, snap connectors for fluid, and electrical connectors for continuous temperature monitoring. Modified with permission from Witt et al.
Figure 3
Figure 3
Example of intraoperative termination of atrial fibrillation with cooling (images as seen remotely). Note that these are capture images from a live, remote transmission, accounting for blurriness. Top: real-time temperature monitoring at the time of AF termination. Bottom: real-time ECG showing termination of AF to normal rhythm.
See this image and copyright information in PMC

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