Histological evaluation of atrial muscle sleeve of pulmonary veins as relevant to trigger mapping and ablation

Gupta, Tulika; Randhawa, Arpan; Sahni, Daisy

doi:10.1007/s00276-020-02473-z

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…All these morphological features predispose the muscle fibres to propagate and promote the aberrant electrical current by providing significant substrates for re-entry (Tan et al, 2006). We also found typical terminal postsynaptic autonomic ganglion in the atrial muscle sleeve of the pulmonary veins (Gupta et al, 2020) which belong to the intrinsic autonomic nervous system (ANS) of the heart. Hyperactive ANS may have important contributions in the focal AF of PV origin (Calkins et al, 2018).…”

Section: Discussionmentioning

confidence: 76%

Identification of novel pulmonary vein nodes as generators of ectopic arrhythmic foci for atrial fibrillation: An immuno-histochemical proof

Gupta

Kaur

Sahni

2021

Preprint

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Introduction: The atrial muscle sleeve (AMS) of the pulmonary vein is the most common source of the arrhythmogenic triggers in atrial fibrillation (AF). Anatomical substrate generating these ectopic currents is still elusive. The present study was designed to study the AMS of pulmonary veins with an emphasis on the structural basis which might govern AF initiation and perpetuation. Materials and Methods: The study was conducted on longitudinal tissue section of pulmonary vein, taken from 15 human cadaveric non-diseased hearts. Tissue was studied histologically using H&E and Gomori trichrome stain. The pacemaker channels were identified by immunohistochemistry using monoclonal HCN4 and HCN1 antibodies. Results: The AMS was identified in each pulmonary vein, located between the tunica adventitia and tunica media. A node like arrangement of myocytes was seen within the AMS in 30% of veins. It had a compact zone limited by a fibrous capsule and contained much smaller, paler and interconnected myocytes. Outside the capsule there was a zone of dispersed, singly placed myocytes separating the compact zone from the working myocytes of the AMS. HCN4 and HCN1 antibodies were expressed on the cell membrane of nodal myocytes, while the working myocytes demonstrated none to minimal staining. Conclusion: Pulmonary veins nodes are similar to the specialized cardiac conductive tissue in, histological arrangement of compact and transitional zones, cellular characteristics, and the presence of pacemaker channels. They might be the anatomical basis of ectopic arrhythmogenic foci. To our knowledge these nodes are being described for the first time in human.

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Section: Discussionmentioning

confidence: 76%

Identification of novel pulmonary vein nodes as generators of ectopic arrhythmic foci for atrial fibrillation: An immuno-histochemical proof

Gupta

Kaur

Sahni

2021

Preprint

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“…Conversely, excessive ablation for thin walls may bring damage to extracardiac structures. Furthermore, the composition of left atrial wall was not uniform at different anatomical site of left atrium, which may influence the conduction of radiofrequency heat to deep myocardial tissue ( 6 ). In this study, we found that IIRs tended to be higher at posterior wall of PV compared to the anterior wall of PV when similar ablation parameters were applied during PVI.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that the left atrium wall thickness is not uniform under the catheter ablation line, and excessive ablation for thin walls may induce potential damage to extracardiac structures ( 5 ). Furthermore, histological studies have revealed that the area surrounding the pulmonary veins (PVs) is anatomically heterogeneous ( 6 ). Based on these features, we hypothesized that similar ablation parameters applied during radiofrequency ablation may cause different tissue lesion at different location of left atrium.…”

Section: Introductionmentioning

confidence: 99%

Quantitative late gadolinium enhancement cardiac magnetic resonance analysis of the relationship between ablation parameter and left atrial tissue lesion following pulmonary vein isolation

Wang

Huang²,

Huo³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThe impact of ablation parameters on acute tissue lesion formation after pulmonary vein isolation (PVI) has not been sufficiently evaluated in patients with atrial fibrillation. Radiofrequency ablation lesion can be visualized by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). We sought to quantitatively analyze the relationship between ablation parameter and tissue lesion following PVI at different segments of pulmonary vein (PV) using LGE-CMR.MethodsTwenty-one patients with atrial fibrillation who underwent PVI procedure were retrospectively enrolled. All patients underwent LGE-CMR examination within 3 days after radiofrequency ablation. Ablation parameters during PVI were documented, including lesion size index (LSI), force–time integral (FTI), power, contact force, temperature, and time of duration. The ablation point was projected onto 3-dimensional (3D) left atrial shell constructed base on LGE-CMR and corresponding image intensity ratio (IIR) was calculated on the same shell. A tissue lesion point was defined when the LGE-CMR IIR was > 1.2.ResultsIn total, 1,759 ablation points were analyzed. The ablation parameters and IIRs for each PV segment were significantly different (P < 0.0001). IIRs corresponding to ablation points at posterior of PV tended to be higher than those at non-posterior of PV when similar ablation parameters were applied during ablation. LSI was a better predictor of tissue lesion existence following PVI than FTI, contact force, power, temperature, and duration time at non-posterior wall of PV. The IIR showed positive correlation with LSI at non-posterior wall of PV (non-posterior of right PV, r = 0.13, P = 0.001, non-posterior of left PV, r = 0.26, P < 0.0001).ConclusionWhen similar ablation parameters were applied during PVI, the posterior wall of PV had more severe tissue lesion than non-posterior wall of PV. Therefore, it was reasonable to decrease ablation energy at posterior wall of PV. Moreover, LSI was a better index to reflect tissue lesion quality following PVI at non-posterior of PV.

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“…There is substantial clinical data proving that pulmonary veins have the capacity to generate aberrant electric currents; 90-95% of atrial fibrillations are triggered by foci located on the atrial muscle sleeve present in the walls of pulmonary veins. Radiofrequency catheter ablation of these triggers points is the preferred treatment for atrial fibrillation with drug resistance and is considered the first line of treatment in paroxysmal atrial fibrillation (Gupta et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…The pulmonary veins have demonstrated electrical activity even when they are disconnected from the heart (Jais, 2000;Marrouche et al, 2002;Yamane et al, 2001). Moreover, drug resistant arrhythmia is treated by radiofrequency catheter ablation of pulmonary vein walls or PV antral isolation (Gupta et al, 2020). These facts establish the presence of triggers or specialised cardiac conductive cells in pulmonary vein walls but the anatomical basis of these triggers is not yet understood.…”

Section: Introductionmentioning

confidence: 99%

Identification of novel pulmonary vein nodes as generators of ectopic arrhythmic foci for atrial fibrillation: an immunohistochemical proof

2022

Self Cite

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Introduction:The atrial muscle sleeve (AMS) of the pulmonary vein is the most common source of the arrhythmogenic triggers in atrial fibrillation (AF). Anatomical substrate generating these ectopic currents is still elusive. The present study was designed to study the AMS of pulmonary veins with an emphasis on the structural basis which might govern AF initiation and perpetuation. Materials and Methods:The study was conducted on longitudinal tissue section of pulmonary vein, taken from 15 human cadaveric non-diseased hearts. Tissue was studied histologically using H&E and Gömöri trichrome stain. The pacemaker channels were identified by immunohistochemistry using monoclonal HCN4 and HCN1 antibodies. Results:The AMS was identified in each pulmonary vein, located between the tunica adventitia and tunica media. A node like arrangement of myocytes was seen within the AMS in 30% of veins. It had a compact zone limited by a fibrous capsule and contained much smaller, paler and interconnected myocytes. Outside the capsule there was a zone of dispersed, singly placed myocytes separating the compact zone from the working myocytes of the AMS. HCN4 and HCN1 antibodies were expressed on the cell membrane of nodal myocytes, while the working myocytes demonstrated none to minimal staining. Conclusion:Pulmonary veins nodes are similar to the specialized cardiac conductive tissue in, histological arrangement of compact and transitional zones, cellular characteristics, and the presence of pacemaker channels. They might be the anatomical basis of ectopic arrhythmogenic foci. To our knowledge these nodes are being described for the first time in human.

show abstract

Histological evaluation of atrial muscle sleeve of pulmonary veins as relevant to trigger mapping and ablation

Cited by 6 publications

References 19 publications

Identification of novel pulmonary vein nodes as generators of ectopic arrhythmic foci for atrial fibrillation: An immuno-histochemical proof

Identification of novel pulmonary vein nodes as generators of ectopic arrhythmic foci for atrial fibrillation: An immuno-histochemical proof

Quantitative late gadolinium enhancement cardiac magnetic resonance analysis of the relationship between ablation parameter and left atrial tissue lesion following pulmonary vein isolation

Identification of novel pulmonary vein nodes as generators of ectopic arrhythmic foci for atrial fibrillation: an immunohistochemical proof

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