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Mechanisms of postoperative atrial tachycardia following biatrial surgical ablation of atrial fibrillation in relation to the surgical lesion sets.

Abstract：

BACKGROUND:Atrial tachycardia (AT) may develop after biatrial surgical ablation of atrial fibrillation. However, the mechanism has not been determined in detail. OBJECTIVE:We aimed to determine the mechanism and treatment of postoperative AT following biatrial surgical ablation in relation to the design and durability of the surgical lesion sets. METHODS:An electrophysiologic study and radiofrequency ablation were performed in 34 consecutive patients (23 male, mean age of 63 ± 9.4 years) who were referred for AT that developed late after biatrial surgical ablation. RESULTS:The mechanism of a total of 53 ATs was macroreentry in 30, a focal mechanism in 20, and localized reentry in 1, and could not be determined in 2. The cause of the macroreentrant AT was residual conduction across a surgical lesion, most of which was located at the annular end of the mitral (n = 18) or tricuspid isthmus incision (n = 7), where cryoablation was applied during the surgery. We did not find any gaps across the cut-and-sew lesions. Radiofrequency (RF) applications to the gap, or an alternative site to transect the circuit, or the earliest activation site of the focus was effective for 48 ATs (91%). After a total of 1.3 ± 0.6 RF sessions, 27 patients (79%) were free of AT (n = 2) or AF (n = 5) during a follow-up period of 50 ± 49 months. CONCLUSIONS:Macroreentry due to a gap in a surgical lesion and focal AT were the major mechanisms of AT in patients after biatrial surgical ablation. Radiofrequency ablation of those ATs is feasible.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Takahashi K,Miyauchi Y,Hayashi M,Iwasaki YK,Yodogawa K,Tsuboi I,Hayashi H,Oka E,Ito Hagiwara K,Fujimoto Y,Shimizu W

doi

10.1016/j.hrthm.2015.12.033

subject

Has Abstract

pub_date

2016-05-01 00:00:00

pages

1059-1065

issue

5

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(15)01668-9

journal_volume

13

pub_type

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