The superior transseptal surgical approach to mitral valve creates slow conduction
Open accessAbstract
BACKGROUND: Atrial tachycardia is very frequent after mitral valve surgery using the superior transseptal approach. METHODS: Sixteen patients operated on for mitral valve disease (superior transseptal approach = Group A, n = 9, and left atrial approach = Group B, n = 7) underwent radiofrequency catheter ablation of atrial tachycardia guided by electroanatomic mapping. Twenty-six consecutive patients without previous cardiac surgery with typical atrial flutter served as controls (Group C). RESULTS: Atrial tachycardia occurred earlier after the operation in Group A than in Group B (median 97 vs 2,159 days, P = 0.003). Typical atrial flutter was the most frequent circuit in all groups (Group A-7 patients, Group B-5 patients, Group C-26 patients). Three patients in Group A developed right atrial incisional tachycardia. Ten of 14 tachycardia circuits (typical atrial flutter, n = 7, incisional tachycardia, n = 3) in Group A depended on the corridor between the right atrial part of the atriotomy and the tricuspid annulus. Slow conduction during typical atrial flutter was detected in this corridor in Group A, but not in the corresponding region in Groups B and C (P < 0.001). The cycle length of typical atrial flutter was longer in Groups A and B than in Group C (mean 283 ms and 282 ms vs 233 ms, P = 0.003). Patients in Group B with typical atrial flutter had larger right atria than patients in Group A or Group C (mean 156 mL vs 96 mL and 113 mL, P = 0.033). CONCLUSIONS: The superior transseptal incision may predispose to atrial tachycardia by creating slow conduction between the atriotomy and the tricuspid annulus.
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The superior transseptal surgical approach to mitral valve repair or replacement is more arrhythmogenic than direct posterior left atrial atriotomy, leading to macroreentrant tachycardia circuits involving both atria that are difficult to eliminate by ablation.
“The superior transseptal surgical approach to mitral valve repair or replacement is more arrhythmogenic than direct posterior LA atriotomy, leading to the appearance of MRT circuits involving both atria, and that are difficult to eliminate by ablation.160,200”
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 [200]
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Importance of Atrial Flutter Isthmus in Postoperative Intra-Atrial Reentrant Tachycardia
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Atrial Incision Affects the Incidence of Atrial Tachycardia After Mitral Valve Surgery
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Katritsis, D. G., Boriani, G., Cosio, F. G., Hindricks, G., Jaïs, P., Josephson, M. E., Keegan, R., Kim, Y.-H., Knight, B. P., Kuck, K.-H., et al. (2017) · Europace · doi:10.1093/europace/euw301 · Cited by 188 · see citing works
- Authors
- LUKAC, P., HJORTDAL, V., PEDERSEN, A. K., JENSEN, H. K., MORTENSEN, P. T., & HANSEN, P. S.
- Affiliations
- Aarhus University Hospital (DK)
- Venue
- Pacing and Clinical Electrophysiology
- Publisher
- Wiley
- Published
- 2006-07
- Volume
- 29
- Issue
- 7
- Pages
- 719-726
- ISSN
- 0147-8389 (ISSN-L)
- 1540-8159
- OpenAlex
- W1973021912
- Cited by
- 24
- References
- 12
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 3 · 2015: 1 · 2014: 3 · 2012: 2
- FWCI
- 0.47
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Pacing and Clinical Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion)
- Funders
- Hjerteforeningen
- European Society of Cardiology
- Slovenská Kardiologická Spoločnost
- 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
- mitral valve surgery, atrial tachycardia, atrial flutter, slow conduction, atriotomy, tricuspid annulus, radiofrequency catheter ablation, electroanatomical mapping, postoperative arrhythmia, right atrial enlargement
- MeSH terms
- Adult, Aged, Analysis of Variance, Atrial Fibrillation, Atrial Flutter, Female, Heart Conduction System, Heart Septum, Humans, Male, Middle Aged, Mitral Valve Insufficiency, Retrospective Studies, Treatment Outcome, Catheter Ablation, Statistics, Nonparametric, Electrophysiologic Techniques, Cardiac
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