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First confirmation of histologic changes in the human heart after cryoballoon ablation  Tatsuhiko Hirao, MD, Junichi Nitta, MD, PhD, Akiko Adachi, MD,

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Presentation on theme: "First confirmation of histologic changes in the human heart after cryoballoon ablation  Tatsuhiko Hirao, MD, Junichi Nitta, MD, PhD, Akiko Adachi, MD,"— Presentation transcript:

1 First confirmation of histologic changes in the human heart after cryoballoon ablation 
Tatsuhiko Hirao, MD, Junichi Nitta, MD, PhD, Akiko Adachi, MD, Yoshihide Takahashi, MD, PhD, Masahiko Goya, MD, PhD, Kenzo Hirao, MD, PhD, FHRS  HeartRhythm Case Reports  Volume 5, Issue 2, Pages (February 2019) DOI: /j.hrcr Copyright © 2018 Heart Rhythm Society Terms and Conditions

2 Figure 1 Voltage mapping of the left atrium and pulmonary veins after cryoballoon ablation with all pulmonary veins electrically isolated. LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein. HeartRhythm Case Reports 2019 5, 93-96DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

3 Figure 2 A: Developed view of the left atrium (LA). In gross pathologic findings, the lesion after cryoballoon ablation of the LA is unclear, but after careful review, it is evident that the lesion has changed to a pale beige color. B: Macroscopic pathology of the radiofrequency lesion of the inferior vena cava (IVC)–tricuspid isthmus. Subintimal hemorrhage in the lesion is observed. LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; RFCA = radiofrequency catheter ablation; RIPV = right inferior pulmonary vein; RSPV = right superior pulmonary vein. HeartRhythm Case Reports 2019 5, 93-96DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

4 Figure 3 Histologic samples stained with Azan. Fibrotic tissue is blue, and muscle tissue is red. A: Medium-power field of the cryoballoon lesion in the right inferior pulmonary vein antrum. A transmural lesion that had been replaced with fibrotic tissue is observed in the vein. No thrombus formation is observed in the lesion. Inset (upper right) shows the high-power field of the yellow square area. The area is not completely replaced with fibrotic tissue like the endocardial part; however, fibrous granulation tissue formation is observed with myocardial destruction, and there is no normal formation of atrial muscle. With time, macrophages will phagocytize these tissues and induce fibrosis, but because only 6 months have passed since ablation, the process of fibrosis is not yet complete. B: Low-power field of the cryoballoon lesion of the right superior pulmonary vein (RSPV) antrum. The width of the transmural lesion is 6 mm. C: Medium-power field of the radiofrequency lesion of the inferior vena cava–tricuspid isthmus. The patchy fibrotic tissue is stained blue by Azan and not clearly demarcated from the normal myocardium. D: Medium-power field of the radiofrequency lesion of the inferior vena cava–tricuspid isthmus with Azan staining. Gray pigmentation of hemosiderin is observed in the subintimal area of the lesion. LA = left atrium. HeartRhythm Case Reports 2019 5, 93-96DOI: ( /j.hrcr ) Copyright © 2018 Heart Rhythm Society Terms and Conditions

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