Where to draw the mitral isthmus line in catheter ablation of atrial fibrillation: histological analysis
Aims A linear lesion between the left inferior pulmonary vein orifice and mitral annulus, the so-called mitral isthmus, may improve the success of catheter ablation for atrial fibrillation. Gaps in the lesion line, however, may facilitate left atrial flutter. The aim of the study was to determine th...
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| Veröffentlicht in: | European heart journal 2005-04, Vol.26 (7), p.689-695 |
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| creator | Wittkampf, Fred H.M. van Oosterhout, Matthijs F. Loh, Peter Derksen, Richard Vonken, Evert-jan Slootweg, Piet J. Ho, Siew Yen |
| description | Aims A linear lesion between the left inferior pulmonary vein orifice and mitral annulus, the so-called mitral isthmus, may improve the success of catheter ablation for atrial fibrillation. Gaps in the lesion line, however, may facilitate left atrial flutter. The aim of the study was to determine the optimal location of the lesion line by serial sectioning of the isthmus area. Methods and results In a post-mortem study of 16 patients with normal left atria, serial sections of the isthmus area from 10 mm superior to and 30 mm inferior to the isthmus were studied by light microscopy. The length of the isthmus was 35±7 mm. On average, the muscle sleeve around the coronary sinus ended 10 mm inferior to the isthmus. The prevalence of a ramus circumflexus |
| doi_str_mv | 10.1093/eurheartj/ehi095 |
| format | Article |
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Gaps in the lesion line, however, may facilitate left atrial flutter. The aim of the study was to determine the optimal location of the lesion line by serial sectioning of the isthmus area. Methods and results In a post-mortem study of 16 patients with normal left atria, serial sections of the isthmus area from 10 mm superior to and 30 mm inferior to the isthmus were studied by light microscopy. The length of the isthmus was 35±7 mm. On average, the muscle sleeve around the coronary sinus ended 10 mm inferior to the isthmus. The prevalence of a ramus circumflexus <5 mm from the endocardial surface, decreased from 60% in the most superior section to 0% in the most inferior section. Atrial arteries were frequently present in all sections. Conclusions The thickness of atrial myocardium, the ramus circumflexus sometimes very close to the endocardium, a myocardial sleeve around the coronary sinus, and local cooling by atrial arteries and veins may complicate the creation of conduction block in the mitral isthmus.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehi095</identifier><identifier>PMID: 15637084</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Atrial fibrillation ; Atrial Fibrillation - pathology ; Atrial Fibrillation - surgery ; Autopsy ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Cardiomyopathies - pathology ; Catheter ablation ; Catheter Ablation - methods ; Heart ; Humans ; Medical sciences ; Middle Aged ; Mitral Valve - pathology</subject><ispartof>European heart journal, 2005-04, Vol.26 (7), p.689-695</ispartof><rights>2005 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Apr 2005</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c527t-523035c5e12dd9a3f9965050b45181ec8503478a4741e47b7f4d4fa58665fc293</citedby><cites>FETCH-LOGICAL-c527t-523035c5e12dd9a3f9965050b45181ec8503478a4741e47b7f4d4fa58665fc293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16662320$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15637084$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wittkampf, Fred H.M.</creatorcontrib><creatorcontrib>van Oosterhout, Matthijs F.</creatorcontrib><creatorcontrib>Loh, Peter</creatorcontrib><creatorcontrib>Derksen, Richard</creatorcontrib><creatorcontrib>Vonken, Evert-jan</creatorcontrib><creatorcontrib>Slootweg, Piet J.</creatorcontrib><creatorcontrib>Ho, Siew Yen</creatorcontrib><title>Where to draw the mitral isthmus line in catheter ablation of atrial fibrillation: histological analysis</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims A linear lesion between the left inferior pulmonary vein orifice and mitral annulus, the so-called mitral isthmus, may improve the success of catheter ablation for atrial fibrillation. Gaps in the lesion line, however, may facilitate left atrial flutter. The aim of the study was to determine the optimal location of the lesion line by serial sectioning of the isthmus area. Methods and results In a post-mortem study of 16 patients with normal left atria, serial sections of the isthmus area from 10 mm superior to and 30 mm inferior to the isthmus were studied by light microscopy. The length of the isthmus was 35±7 mm. On average, the muscle sleeve around the coronary sinus ended 10 mm inferior to the isthmus. The prevalence of a ramus circumflexus <5 mm from the endocardial surface, decreased from 60% in the most superior section to 0% in the most inferior section. Atrial arteries were frequently present in all sections. Conclusions The thickness of atrial myocardium, the ramus circumflexus sometimes very close to the endocardium, a myocardial sleeve around the coronary sinus, and local cooling by atrial arteries and veins may complicate the creation of conduction block in the mitral isthmus.</description><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - pathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Autopsy</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Cardiomyopathies - pathology</subject><subject>Catheter ablation</subject><subject>Catheter Ablation - methods</subject><subject>Heart</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mitral Valve - pathology</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1rFTEUxYNY7LO6dyVB0N20-c7EXSmtFSq6qPpwEzKZxMlzZlKTDG3_eyPzaMGNq0DO71zuPQeAVxgdY6ToiVvS4EwquxM3BKT4E7DBnJBGCcafgg3CijdCtNtD8DznHUKoFVg8A4eYCypRyzZg-D645GCJsE_mFpbBwSmUZEYYchmmJcMxzA6GGVpTxeISNN1oSogzjB6akkJlfehSGNfv93Co1jjGn8FWycxmvM8hvwAH3ozZvdy_R-Drxfn12WVz9fnDx7PTq8ZyIkvDCUWUW-4w6XtlqFdKcMRRxzhusbMtR5TJ1jDJsGOyk571zBveCsG9JYoegXfr3JsUfy8uFz2FbF1dbnZxyVpIThijuIJv_gF3cUl126wJ5kyxmuF_IVSXqhBaIZtizsl5fZPCZNK9xkj_7Uk_9KTXnqrl9X7u0k2ufzTsi6nA2z1gco3RJzPbkB85IQShBFWuWbmaubt70E36VS-lkuvL7Q_9SbIv10ps9Tf6B1hgrQ8</recordid><startdate>20050401</startdate><enddate>20050401</enddate><creator>Wittkampf, Fred H.M.</creator><creator>van Oosterhout, Matthijs F.</creator><creator>Loh, Peter</creator><creator>Derksen, Richard</creator><creator>Vonken, Evert-jan</creator><creator>Slootweg, Piet J.</creator><creator>Ho, Siew Yen</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20050401</creationdate><title>Where to draw the mitral isthmus line in catheter ablation of atrial fibrillation: histological analysis</title><author>Wittkampf, Fred H.M. ; van Oosterhout, Matthijs F. ; Loh, Peter ; Derksen, Richard ; Vonken, Evert-jan ; Slootweg, Piet J. ; Ho, Siew Yen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c527t-523035c5e12dd9a3f9965050b45181ec8503478a4741e47b7f4d4fa58665fc293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - pathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Autopsy</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Cardiomyopathies - pathology</topic><topic>Catheter ablation</topic><topic>Catheter Ablation - methods</topic><topic>Heart</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mitral Valve - pathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wittkampf, Fred H.M.</creatorcontrib><creatorcontrib>van Oosterhout, Matthijs F.</creatorcontrib><creatorcontrib>Loh, Peter</creatorcontrib><creatorcontrib>Derksen, Richard</creatorcontrib><creatorcontrib>Vonken, Evert-jan</creatorcontrib><creatorcontrib>Slootweg, Piet J.</creatorcontrib><creatorcontrib>Ho, Siew Yen</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wittkampf, Fred H.M.</au><au>van Oosterhout, Matthijs F.</au><au>Loh, Peter</au><au>Derksen, Richard</au><au>Vonken, Evert-jan</au><au>Slootweg, Piet J.</au><au>Ho, Siew Yen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Where to draw the mitral isthmus line in catheter ablation of atrial fibrillation: histological analysis</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>2005-04-01</date><risdate>2005</risdate><volume>26</volume><issue>7</issue><spage>689</spage><epage>695</epage><pages>689-695</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims A linear lesion between the left inferior pulmonary vein orifice and mitral annulus, the so-called mitral isthmus, may improve the success of catheter ablation for atrial fibrillation. Gaps in the lesion line, however, may facilitate left atrial flutter. The aim of the study was to determine the optimal location of the lesion line by serial sectioning of the isthmus area. Methods and results In a post-mortem study of 16 patients with normal left atria, serial sections of the isthmus area from 10 mm superior to and 30 mm inferior to the isthmus were studied by light microscopy. The length of the isthmus was 35±7 mm. On average, the muscle sleeve around the coronary sinus ended 10 mm inferior to the isthmus. The prevalence of a ramus circumflexus <5 mm from the endocardial surface, decreased from 60% in the most superior section to 0% in the most inferior section. Atrial arteries were frequently present in all sections. Conclusions The thickness of atrial myocardium, the ramus circumflexus sometimes very close to the endocardium, a myocardial sleeve around the coronary sinus, and local cooling by atrial arteries and veins may complicate the creation of conduction block in the mitral isthmus.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>15637084</pmid><doi>10.1093/eurheartj/ehi095</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; EZB-FREE-00999 freely available EZB journals |
| subjects | Atrial fibrillation Atrial Fibrillation - pathology Atrial Fibrillation - surgery Autopsy Biological and medical sciences Cardiac dysrhythmias Cardiology. Vascular system Cardiomyopathies - pathology Catheter ablation Catheter Ablation - methods Heart Humans Medical sciences Middle Aged Mitral Valve - pathology |
| title | Where to draw the mitral isthmus line in catheter ablation of atrial fibrillation: histological analysis |
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