Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy.
Europace. 2011 Aug;13(8):1133-40. doi: 10.1093/europace/eur068. Epub 2011 Mar 29.
Histological studies support the important role of inflammation in the initiation and maintenance of atrial fibrillation (AF). We describe a novel and safe technique of atrial biopsy during AF radiofrequency catheter ablation (RFCA) to investigate the role of atrial tissue inflammation.
We enrolled 70 consecutive patients (age 60 ± 12 years, 49 males) undergoing RFCA for AF. The control group was represented by 10 patients with Wolff-Parkinson-White syndrome undergoing trans-septal puncture. Atrial biopsies were obtained by washing the dilator and needle used for trans-septal puncture with 20 mL sterile phosphate-buffered saline. The presence of intracytoplasmic C-reactive protein was assessed in formalin-fixed atrial specimens by immunohistochemistry. A sufficient amount of atrial tissue was obtained in 23/70 (32%) patients with AF and in 4/10 (40%) of the control group. Intracytoplasmic localization of C-reactive protein was found in isolated atrial cardiomyocytes in 11 (73%) of 15 patients with paroxysmal AF as compared with 2 (25%) of eight patients with persistent AF (P= 0.02).
In this study, we demonstrate the safety and feasibility of a novel technique to obtain atrial specimens during routine trans-septal puncture. Local inflammation assessed by atrial tissue localization of C-reactive protein is more likely involved in paroxysmal rather than in persistent AF.
组织学研究支持炎症在心房颤动（AF）的发生和维持中的重要作用。我们描述了一种在 AF 射频导管消融（RFCA）期间进行心房活检的新的安全技术，以研究心房组织炎症的作用。
我们纳入了 70 例连续接受 AF RFCA 的患者（年龄 60 ± 12 岁，49 例男性）。对照组由 10 例接受经房间隔穿刺的 Wolff-Parkinson-White 综合征患者代表。通过用 20 毫升无菌磷酸盐缓冲盐水冲洗用于经房间隔穿刺的扩张器和针头，获得心房活检。通过免疫组织化学评估福尔马林固定的心房标本中细胞质内 C 反应蛋白的存在。在 70 例 AF 患者中的 23 例（32%）和对照组的 4 例（40%）中获得了足够量的心房组织。与持续 AF 的 8 例患者中的 2 例（25%）相比，在 15 例阵发性 AF 患者中的 11 例（73%）中发现了细胞质内 C 反应蛋白的细胞内定位（P=0.02）。
在这项研究中，我们证明了在常规经房间隔穿刺期间获得心房标本的一种新的安全技术的安全性和可行性。通过心房组织中 C 反应蛋白的定位评估的局部炎症更可能与阵发性而非持续性 AF 有关。
