Innovations in cardiovascular pathology: anatomic and electrophysiologic determinants associated with ablation of atrial arrhythmias.

The pathologist is required to evaluate hearts and surgical specimens following innovative therapies to ablate arrhythmias. For the treatment or cure of atrial fibrillation, ablation of the pulmonary vein sleeves and left atrium is increasingly encountered. The recognized contribution of the right atrium, Bachmann's bundle and other sites such as the vein of Marshall and epicardial ganglia has given rise to specific procedures to target these areas. Improved and safe power sources are needed to achieve these goals. Catheters and devices have been developed using different energy types to create therapeutic lesions. The pathologist will encounter different sources of energy and catheter and probe device modifications for surgical and catheter-based endocardial and epicardial therapy. This article reviews the pathology of ablation and the recent innovations in the treatment of atrial arrhythmias.