Histopathologic Characterization of Chronic Radiofrequency Ablation Lesions for Pulmonary Vein Isolation

Abstract

PVs showing electrical reconnection after catheter-based antral ablation frequently reveal anatomic gaps or nontransmural lesions at the sites of catheter ablation. Nontransmural lesions are noted in some PVs with persistent conduction block, suggesting that lesion geometry may influence PV conduction. The histological findings show that nontransmural ablation can produce a dynamic cellular substrate with features of reversible injury. Delayed recovery from injury may explain late recurrences of AF after PV isolation.

Clinical Implication of Adenosine Test at Repeat Atrial Fibrillation Ablation Procedure

“…Recently, Kowalski demonstrated that PVs showing electrical reconnection after catheter-based antral ablation frequently reveal anatomic gaps or nontransmural lesions at the sites of catheter ablation, and that return of PV conduction after catheter-based isolation procedures is assumed to be attributable to failure to create permanent contiguous transmural lesions in at least part of the ablation line by histological study. 18 …”

Status of Antiarrhythmic Drug Development for Atrial Fibrillation

“…67,68 Recovery of conduction may be due, in part, to local tissue regeneration in nontransmural ablation lesions and reversibility of thermal injury seems to be an important determinant of recovery of conduction. 69 Colchicine could intervene in this process through its antiproliferative action, inhibiting electric reconnection in thermal injury ablation sites.…”

Catheter Ablation of Paroxysmal Atrial Fibrillation: Have We Achieved Cure with Pulmonary Vein Isolation?

“…Kowalski et al reported the histopathologic and electrophysiologic findings in patients with recurrent AF after PVI who underwent a surgical maze procedure. 27 The authors collected full-thickness surgical biopsy specimens in areas of the PV antrum where endocardial scar was visible. Interestingly, the authors found that presence of conduction block did not consistently correlate with the presence of transmural lesions at histopathological analysis.…”