Abstract
Radiofrequency ablation (RFA) utilizing half-normal saline (HNS) as irrigant causes larger volume ablation lesions. Few analyses of cardiovascular magnetic resonance imaging (CMR) and histopathologic examinations have been performed in patients who have undergone such an ablation. To describe the CMR, histologic and gross pathologic characteristics of HNS RFA lesions. Three patients with symptomatic ventricular tachycardia who underwent sequential or concurrent endocardial/epicardial bipolar HNS RFA were analyzed. CMR was performed prior to and following HNS RFA in one patient. Anatomic and histologic pathology were assessed on the remaining two patients at time of either heart transplantation or autopsy. In one patient, CMR following HNS RFA revealed new transmural delayed gadolinium enhancement with central lack of enhancement suggestive of intramyocardial hematoma (arrow). Gross pathology shows increased depth and volume of lesions on the septum that are larger (asterisk) than the “tear-drop” 4mm lesion characteristics of traditional irrigated RFA. Histopathologic assessment following HNS RFA reveals acute coagulative necrosis in the peri-ablative region transitioning to hemorrhagic necrosis and then viable myocardium demonstrating robust inflammatory response in the form of perifascicular neutrophilic infiltration. HNS RFA results in large ablative volumes, deeper lesions, characterized by acute coagulative necrosis, regions of hemorrhagic necrosis and accentuated local inflammation. These findings seem to correlate across gross pathology, tissue response and CMR assessment.
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