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European Heart Journal Advance Access originally published online on April 26, 2005
European Heart Journal 2005 26(17):1797-1803; doi:10.1093/eurheartj/ehi255
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Histopathology of intraoperatively induced linear radiofrequency ablation lesions in patients with chronic atrial fibrillation

Thomas Deneke1,3,*, Krishna Khargi2, Klaus-Michael Müller3, Bernd Lemke1, Andreas Mügge1, Axel Laczkovics2, Anton E. Becker4 and Peter H. Grewe1,3

1Medical Clinic II (Cardiology and Angiology), BG Kliniken Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
2Clinic for Cardio-Thoracic Surgery, BG Kliniken Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
3Institute of Pathology, BG Kliniken Bergmannsheil, Ruhr-University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
4Department of Cardiovascular Pathology, Academic Medical Centre, University of Amsterdam, The Netherlands

Received 20 December 2004; revised 21 February 2005; accepted 3 March 2005; online publish-ahead-of-print 26 April 2005.

* Corresponding author. Tel: +49 234 302 6077; fax: +49 234 302 6084. E-mail address: thomas.deneke{at}ruhr-uni-bochum.de

Aims Radiofrequency (RF) energy has been extensively used in ablation of arrhythmia but so far no analysis of morphological effects in human left atria has been conducted.

Methods and results We studied 59 ablation lesions from seven patients who died 2 to 22 days after open heart surgery plus intraoperative cooled-tip RF ablation to treat permanent atrial fibrillation (AF) (mean 4, 1–11 years). The ablation area was studied by macroscopy and histological analysis. RF ablation produced clearly delineated coagulation necrosis (up to a depth of 5.5 mm) bordered by an irregular zone of incomplete necrosis and fresh bleeding even 22 days post-operatively. No superficial charring, thrombotic deposition, or perforation was documented. Endocardium and subendocardium displayed oedematic loosening and microfragmentation of connective tissue fibres. Early after ablation (2–6 days), interfibrillar disseminated bleeding and necrosis without tissue removal response were found. Later after ablation (21, 22 days), mild inflammatory reaction and granulation tissue appeared. Twenty-five per cent of all studied lesions, especially in the thick region in between left pulmonary veins and mitral annulus (left atrial isthmus) (86%), were non-transmural. Nerve fibres with different degrees of thermal injury were detected in the pulmonary vein ostial region.

Conclusion Intraoperative cooled-tip ablation in AF resulted in coagulation necrosis of endocardium, subendocardium, and the atrial myocardial layer to a depth of 5.5 mm bordered by an irregular zone of incomplete thermal damage. Transmurality of the lesions could only be found in 75% of intraoperatively applied lesions.

Key Words: Radiofrequency ablation • Atrial fibrillation • Pathology • Histomorphology


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