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Eur J Cardiothorac Surg 2003;24:481-486
© 2003 Elsevier Science NL
a Heart Institute, Instituto do Coração, Av. Prof. Reynaldo dos Santos 27, 2795-563 Carnaxide, Portugal
b Santa Cruz Hospital, Carnaxide, Portugal
Received 30 September 2002; received in revised form 13 May 2003; accepted 26 May 2003.
* Corresponding author. Tel.: +351-214-165-900; fax: +351-214-165-918
e-mail: teresa.santiago{at}incor.pt
Objectives: To obtain a better understanding of tissue damage induced in human atria by epicardial radiofrequency ablation and its correlation with intra-tissue temperatures measured sub-epicardially and sub-endocardially. Methods: Radiofrequency (RF) currents were delivered to human atrial tissues using experimental set-ups to simulate surgical RF epicardial ablation at 80, 85 and 90 °C. Sub-endocardial and sub-epicardial temperatures were measured with thermocouples during the ablations. Twelve samples from in vitro epicardial ablations were histologically assessed. Localized RF epicardial ablations at same temperatures were performed on 38 mitral patients with concomitant atrial fibrillation (AF) before full cardiopulmonary bypass and samples histologically assessed. All patients had endocardial RF ablation at 70 °C to treat AF. Results: In vitro: Sub-endocardial temperatures were lower than 50 °C except on thin atria (
2–3 mm) in ablations at 80 and 85 °C and on thicker atria (5 mm) in ablations at 90 °C. Lesions measured 0.85–1.98 mm, all showed epicardial and myocardial damage but none were transmural. Mitral patients: Lesions measured 0.38–3.25 mm and 13/25 induced at 70 °C, 2/8 at 80 °C, 1/4 at 85 °C and 0/1 at 90 °C were confined to the epicardium leaving the myocardium undamaged. The remaining had damage of the epicardium and of variable portions of the myocardium, and three were transmural. Conclusions: The application temperature and the intra-tissue temperature are not the sole factors that determine lesion depth. The thickness and the composition of the epicardium and of the myocardium are major determinants in the formation of the lesion.
Key Words: Radiofrequency ablation • Tissue temperature • Lesion histology
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