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Ann Thorac Surg 2004;78:1397-1402
© 2004 The Society of Thoracic Surgeons
a Departments of Cardiothoracic Surgery and Physiology, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands, Department of Surgery and the Center for Minimally Invasive and Robotic Surgery, and Department of Comparative Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
Accepted for publication April 1, 2004.
* Address reprint requests to Dr van Brakel, Department of Cardiothoracic Surgery, Cardiovascular Research Institute Maastricht, University Hospital Maastricht, P. Debyelaan 25, Postbus 5800, 6202 AZ Maastricht, the Netherlands
t.vanbrakel{at}ctc.unimaas.nl
Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.
BACKGROUND: Pulmonary vein isolation is a hallmark in current surgical ablation for atrial fibrillation. However, validation of isolation remains cumbersome. We evaluated electrophysiologic and not histologic means to test isolation.
METHODS: In 16 mongrel dogs, robot-assisted epicardial beating-heart microwave ablation (FLEX 10) was performed around the pulmonary veins. Electrophysiologic isolation was tested by pacing at 4 times threshold values inside and outside the pulmonary veins (exit and entrance block). The histology of lesions was studied for transmurality and continuity of the lesion lines. In 5 dogs, lesions were studied at various time intervals.
RESULTS: Histologic evaluation of the lesions showed incomplete (48% ± 20%) circumferential myocardial damage in all dogs with acute lesions. Electrophysiologic evaluation showed completion of the box (entrance and exit block) in 8 dogs and in another 5 dogs after repeated ablation (p < 0.01 compared with histologic evaluation). Electrophysiologic evaluation of the dogs with chronic lesions showed completed lesions in 4 of 5 dogs directly after ablation. At follow-up (1 to 3 weeks), the isolations remained electrophysiologically complete. Histologic evaluation of the lesions 1 to 3 weeks after ablation showed complete (100%) circumferential lesions in all 4 dogs (p < 0.001 compared with the histology of dogs with acute lesions).
CONCLUSIONS: Directly after treatment, ablation lesions are best evaluated electrophysiologically, because complete (transmural and circumferential) lesions are not shown by histologic evaluation in the acute stage. After 1 to 3 weeks, the histology is in accordance with the electrophysiology. To obtain a complete isolation, online electrophysiologic evaluation during pulmonary vein microwave ablation is necessary to optimize the results.
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