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.
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The cause of macroreentrant tachycardia after biatrial surgical ablation of atrial fibrillation has been shown to be gaps with conduction across a surgical lesion, most often toward the annular end of the mitral or tricuspid isthmus incision.
“The cause of MRT after biatrial surgical ablation of atrial fibrillation has been shown to be gaps with conduction across a surgical lesion, most of which were found towards the annular end of the mitral or tricuspid isthmus incision.211”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [211]
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- Authors
- Takahashi, K., Miyauchi, Y., Hayashi, M., Iwasaki, Y.-K., Yodogawa, K., Tsuboi, I., Hayashi, H., Oka, E., Ito Hagiwara, K., Fujimoto, Y., & Shimizu, W.
- Affiliations
- Nippon Medical School (JP)
- Corresponding author
- Miyauchi, Yasushi
- ORCID
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2016-05
- Volume
- 13
- Issue
- 5
- Pages
- 1059-1065
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W2201094535
- Cited by
- 19
- References
- 32
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 7 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 2
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart Rhythm (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, macroreentry, focal atrial tachycardia, cryoablation, radiofrequency ablation, atrial reentry
- MeSH terms
- Aged, Atrial Fibrillation, Cryosurgery, Female, Heart Rate, Humans, Japan, Male, Middle Aged, Postoperative Complications, Retrospective Studies, Tachycardia, Supraventricular, Treatment Outcome, Catheter Ablation, Body Surface Potential Mapping, Electrophysiologic Techniques, Cardiac
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