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Regional left atrial interstitial remodeling in patients with chronic atrial fibrillation undergoing mitral-valve surgery

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Abstract

Ablation of the left atrial free wall around the pulmonary vein ostia (LAFW) may be effective in the treatment of chronic atrial fibrillation associated with mitral disease (CAF-MVD). Using light and conventional electron microscopy analyses, we wanted to evaluate, in CAF-MVD, the interstitial remodeling in the LAFW as well as in a more remote region, such as the left atrial appendage (LAA). LAFW and LAA samples were obtained from 33 CAF-MVD patients during combined mitral surgery and radiofrequency ablation and from 16 autoptic controls. Interstitial fibrosis (IF) and perivascular fibrosis (PF), capillary densities and the maximal oxygen diffusion distance were morphometrically determined. In CAF-MVD patients, the LAFW, compared with the LAA, showed a higher percentage of IF (7.16±3.23% versus 2.51±1.40%, respectively), a lower myocardial capillary density per mm2 (830±106 versus 989±173) and an increased oxygen maximal diffusion distance (19.70±1.27 μm versus 18.13±1.58 μm). All these values were also significantly different than controls. No differences were found in evaluating PF. At variance with the LAA, in CAF-MVD patients, the LAFW around the pulmonary vein ostia is a region characterized by a marked interstitial remodeling such that it may be morphologically indicated as an appropriate target for ablation treatment aimed at sinus rhythm restoration.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Pathology Section, University of Parma, Via Gramsci 14, 43100 , Parma, Italy

    Domenico Corradi & Roberta Maestri

  2. Division of Cardiology, Fidenza Hospital, Fidenza (Parma), Italy

    Sergio Callegari & Paolo Pastori

  3. Cardiothoracic Surgery Unit, Department of Cardiology, San Raffaele University Hospital, Milan, Italy

    Stefano Benussi, Simona Nascimbene, Simone Calvi & Ottavio Alfieri

  4. Department of Clinical Sciences, University of Parma, Parma, Italy

    Ettore Astorri

  5. Clinical Cardiac Electrophysiology and Pacing Unit, Department of Cardiology, San Raffaele University Hospital, Milan, Italy

    Carlo Pappone

Authors
  1. Domenico Corradi
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  2. Sergio Callegari
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  3. Stefano Benussi
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  4. Simona Nascimbene
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  5. Paolo Pastori
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  6. Simone Calvi
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  7. Roberta Maestri
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  8. Ettore Astorri
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  9. Carlo Pappone
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  10. Ottavio Alfieri
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Correspondence to Domenico Corradi.

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Corradi, D., Callegari, S., Benussi, S. et al. Regional left atrial interstitial remodeling in patients with chronic atrial fibrillation undergoing mitral-valve surgery. Virchows Arch 445, 498–505 (2004). https://doi.org/10.1007/s00428-004-1040-2

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  • DOI: https://doi.org/10.1007/s00428-004-1040-2

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