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European Heart Journal Advance Access published online on April 26, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi255
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received December 20, 2004
Revised February 21, 2005
Accepted March 3, 2005

Clinical research

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

Thomas Deneke 1*, Krishna Khargi 2, Klaus-Michael Müller 3, Bernd Lemke 4, Andreas Mügge 4, Axel Laczkovics 2, Anton E. Becker 5, and Peter H. Grewe 1

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

* To whom correspondence should be addressed.
Thomas Deneke, E-mail: thomas.deneke{at}ruhr-uni-bochum.de


  Abstract

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.

Keywords: Radiofrequency ablation; Atrial fibrillation; Pathology; Histomorphology.
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