Lesional tachycardias related to mitral valve surgery
Open accessAbstract
Objectives The purpose of this study was to define the anatomic distribution of electrically abnormal atrial tissue and mechanisms of atrial tachycardia (AT) after mitral valve (MV) surgery.Background Atrial tachycardia is a well-recognized long-term complication of MV surgery. Because atrial incisions from repair of congenital heart defects provide a substrate for re-entrant arrhythmias in the late postoperative setting, we hypothesized that atriotomies or cannulation sites during MV surgery also contributed to postoperative arrhythmias.Methods In 10 patients with prior MV surgery, electroanatomic maps were constructed of 11 tachycardias (6 right atrium [RA], 4 left atrium [LA] and 1 biatrial). Activation and voltage maps were used to identify areas of low voltage, double potentials and conduction block.Results Lesions were present in the lateral wall of the RA (six of seven maps) and in the LA along the septum adjacent to the right pulmonary veins (four of five maps). In 8 of 10 patients, these findings corresponded to atrial incisions or cannulation sites. Arrhythmia mechanisms were identified for 9 of 11 tachycardias. A macro-re-entrant circuit was mapped in six cases, three involving lesions in the lateral wall of the RA and three involving the LA septum and right pulmonary veins. In three of these cases figure-of-eight re-entry was demonstrated, and in the other three a single macro-re-entrant circuit was observed. In three other cases, a focal origin was identified adjacent to abnormal tissue in the RA (two cases) or within a pulmonary vein (one case).Conclusions Surgical incisions for MV surgery provide a substrate for atrial arrhythmias. Both macro-re-entrant and focal mechanisms contribute to AT after MV surgery.
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Atypical atrial flutter/macroreentrant tachycardia of the left atrium is generally supported by abnormal, non-excitable areas of myocardium, sometimes from surgical or ablation scars and sometimes of unknown origin.
“Atypical AFL/MRT of the LA is generally supported by abnormal, non-excitable areas of myocardium, sometimes due to surgical or ablation scars and others of unknown origin.”
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 [192]
Multiple ECG patterns can sometimes be recorded in atypical atrial flutter/macroreentrant tachycardia, suggesting multiple tachycardia mechanisms, especially with structural heart disease, advanced intra-atrial conduction disturbance, surgical atriotomy, or prior atrial fibrillation ablation.
“In some cases more than one ECG pattern can be recorded, suggesting multiple tachycardia mechanisms, especially in the presence of structural heart disease, advanced intra-atrial conduction disturbance, surgical atriotomy, or after catheter ablation for AF.191 -193”
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 [192]
These non-excitable areas may form mixed obstacles by attaching to anatomical obstacles such as the mitral valve or pulmonary veins.
“These non-excitable areas may form mixed obstacles by attaching to anatomical obstacles, such as the mitral valve or the pulmonary veins.118,159,162,191,192”
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 [192]
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- Schematic representation of atrial tachycardias mapped in the left atrium depicting macro-re-entrant circuits, a focal tachycardia and passive activation of the left atrium during a right atrial tachycardia. Color codes and projections are the same as Figure 5. MV ϭ mitral valve; PA ϭ posteroanterior; RAO ϭ right anterior oblique; RL ϭ right lateral; RSPV ϭ the right superior pulmonary vein. 1982 Markowitz et al. JACC Vol. 39, No. 12, 2002 AT After MV Surgery June 19, 2002:1973-83
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- Authors
- Markowitz, S. M., Brodman, R. F., Stein, K. M., Mittal, S., Slotwiner, D. J., Iwai, S., Das, M. K., & Lerman, B. B.
- Affiliations
- Cornell University (US)
- Corresponding author
- Lerman, Bruce B
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2002-06
- Volume
- 39
- Issue
- 12
- Pages
- 1973-1983
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2073957507
- Cited by
- 97
- References
- 10
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 3 · 2022: 4 · 2021: 8 · 2020: 6 · 2019: 6 · 2018: 1 · 2017: 5 · 2016: 5 · 2015: 1 · 2014: 2 · 2013: 3 · 2012: 7
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Raymond and Beverly Sackler Foundation
- U.S. Public Health Service (R01 56139)
- 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 › Epidemiology › Congenital Heart Disease Studies
- Keywords
- atrial tachycardia, mitral valve surgery, postoperative arrhythmia, cannulation site, reentrant arrhythmias, focal atrial tachycardia, electroanatomical mapping
- MeSH terms
- Aged, Female, Heart Atria, Heart Conduction System, Cardiac Surgical Procedures, Heart Valve Diseases, Humans, Male, Middle Aged, Mitral Valve, Tachycardia, Catheter Ablation, Body Surface Potential Mapping, Electrophysiologic Techniques, Cardiac
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