Surgical technique and the mechanism of atrial tachycardia late after open heart surgery

Pap, Róbert; Kohári, Mária; Makai, Attila; Bencsik, Gábor; Traykov, Vassil; Gallardo, Rodrigo A.; Klausz, Gergely; Kis, Zsolt; Forster, Tamás; Sághy, László

doi:10.1007/s10840-012-9705-2

Cited by 30 publications

(38 citation statements)

References 27 publications

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“…It is well known that atrial incisions performed during cardiac surgery can become arrhythmogenic leading to scar-related AT. 7,11,14,18,21 In the present study, compared to patients with surgery for AHD, patients with CHD had nearly a 6-fold greater likelihood of developing noneCTI-dependent AFL.…”

Section: Discussionmentioning

confidence: 48%

Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease

Anguera

Dallaglio

Macías

et al. 2015

The American Journal of Cardiology

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Section: Discussionmentioning

confidence: 48%

Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease

Anguera

Dallaglio

Macías

et al. 2015

The American Journal of Cardiology

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“…It is likely, however, that as the population of adult congenital heart disease patients increases, these co‐morbidities will be more frequently encountered and more relevant to outcomes. Our initial strategy was to avoid any surgical manipulation of the heart outside of the plication procedure as outlined above, due to the potential association with myocardial scaring after atriotomy and ventriculotomy and late post‐operative supraventricular and ventricular arrhythmias identified as contributory to late sudden cardiac death in these patients . However, the technique evolved over time and perventricular valve placement was found to be technically easier to perform in the setting of an open chest, with the potential to reduce the procedure time and radiation doses to the patient, although these changes were not significant in our study due partly to the small numbers involved.…”

Section: Discussionmentioning

confidence: 99%

Hybrid pulmonary artery plication followed by transcatheter pulmonary valve replacement: Comparison with surgical PVR

Sosnowski

Matella

Fogg

et al. 2016

Cathet Cardio Intervent

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Objective/Background Historically, the sole option for patients with a dysfunctional native right ventricular outflow tract (RVOT) requiring re-establishment of pulmonary competence has been surgical PVR. We sought to compare early outcomes of hybrid pulmonary valve replacement (PVR) combining surgical plication of the main pulmonary artery followed by transcatheter PVR, with a contemporary cohort of surgical PVR patients. Methods Retrospective chart analysis of all patients with a dilated native RVOT eligible for surgical PVR over 36 months was performed. The cohorts included patients with previous tetralogy of Fallot repair (n = 14), and previous intervention for congenital abnormality of the pulmonary valve (n = 7). Results Twenty-one patients with a dysfunctional native RVOT met criteria for PVR; 8 using the hybrid procedure (group 1: age, 31.5 +/- 17.4 years) and 13 with cardiopulmonary bypass (CPB) (group 2: age, 31 +/- 18.4 years). Valve delivery was successful in all patients with no procedural mortality. Group 1 had a lesser requirement for blood products (P =< 0.001) and a trend toward shorter hospital stay and higher post-operative hemoglobin. No patients in group 1 received inotropic support post-operatively compared to 54% of patients in group 2. Mean follow-up was 3.4 months for group 1 and 13.6 months for group 2 with the average peak gradient across the RVOT of 20.1 and 15.1 mm Hg respectively (P = 0.12), all with no more than mild PI. Conclusions Transcatheter hybrid PVR following RVOT plication provides a reasonable alternative to surgical PVR particularly in higher risk cohorts, reducing possible longer-term consequences of repeated runs of CPB. © 2016 Wiley Periodicals, Inc.

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“…Right atriotomies for the repair of congenital heart disease, closure of atrial septal defects, or tricuspid valve surgery can predispose to late ATs and are due to cavotricuspid isthmus‐dependent flutter or involve the right atriotomy. When left atriotomies are performed, such as for mitral valve surgery, left ATs are more common, but typical right atrial flutter is still predominant . In surgical ablation of AF (maze procedure) left ATs may develop and are often due to gaps in the surgical ablation lines .…”

Section: Underlying Substrate For Left Atrial Tachycardiasmentioning

confidence: 99%

“…When left atriotomies are performed, such as for mitral valve surgery, left ATs are more common, but typical right atrial flutter is still predominant. 16 In surgical ablation of AF (maze procedure) left ATs may develop and are often due to gaps in the surgical ablation F I G U R E 1 Localized reentrant tachycardia arising from the left atrial septum and adjacent roof in a patient with chronic renal disease and no prior atrial intervention. A, Electroanatomical map shows a figure-of-8 circuit with two lines of the block and central isthmus.…”

Section: Localized Reentry Can Occur In Various Regions In the La Butmentioning

confidence: 99%

Approach to catheter ablation of left atrial flutters

Markowitz

Thomas

Liu

et al. 2019

Cardiovasc electrophysiol

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Left atrial tachycardias (ATs) most commonly occur after catheter or surgical ablation of atrial fibrillation and in patients with atrial myopathies. Pre‐existing scar in the left atrium (LA) can result in complex circuits, sometimes with narrow channels that can be detected with high‐resolution mapping. The most common forms of macroreentrant AT from the LA are variants of peri‐mitral and roof‐dependent reentry. Localized reentrant rhythms occur in the setting of fibrosis that gives rise to slow conduction and may occur adjacent to areas of prior ablation. The approach to treating these ATs involves first identifying the left atrial origin, defining the tachycardia circuit – which can be facilitated by ultrahigh density mapping and entrainment – and selecting a suitable isthmus to target for ablation. An important endpoint in ablating left atrial flutters is to establish and confirm bidirectional line of the block. Challenges in ablating these ATs include the presence of multiple tachycardias, defining circuits with complex activation patterns and achieving durable lines of block, particularly in the lateral mitral isthmus. Progress in treating these arrhythmias has come from new mapping technologies and the recognition of epicardial connections that allow for persistent conduction across ablation lesions. Also, advances in delivering energy to obtain complete transmural lesions promise to improve the long‐term success of ablating ATs from the LA.

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Surgical technique and the mechanism of atrial tachycardia late after open heart surgery

Cited by 30 publications

References 27 publications

Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease

Long-Term Outcome After Ablation of Right Atrial Tachyarrhythmias After the Surgical Repair of Congenital and Acquired Heart Disease

Hybrid pulmonary artery plication followed by transcatheter pulmonary valve replacement: Comparison with surgical PVR

Approach to catheter ablation of left atrial flutters

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