Surface electrocardiographic patterns and electrophysiologic characteristics of atrial flutter following modified radiofrequency MAZE procedures
Open accessAbstract
INTRODUCTION: The radiofrequency MAZE is becoming a common adjunct to cardiac surgery in patients with atrial fibrillation. While a variety of postoperative arrhythmias have been described following the original Cox-MAZE III procedure, the electrophysiological characteristics and surgical substrate of post-radiofrequency MAZE flutter have not been correlated. We sought to determine the location, ECG patterns, and electrophysiological characteristics of post-radiofrequency MAZE atrial flutter. METHODS: Nine consecutive patients with post-radiofrequency MAZE flutter presented for catheter ablation 9 +/- 10 months after surgery. RESULTS: Only one patient (11%) had an ECG appearance consistent with typical isthmus-dependent right atrial (RA) flutter. However, on electrophysiological study, 3/9 patients (33%) had typical right counter-clockwise flutter entrained from the cavo-tricuspid isthmus, despite description of surgical isthmus ablation. Six patients (67%) had left atrial (LA) circuits. These involved the mitral annulus in 5/6 cases (83%) despite description of surgical mitral isthmus ablation in the majority (60%). LA flutters had a shorter cycle length compared with RA flutters (253 +/- 39 msec and 332 +/- 63 msec respectively, P < 0.05). After a mean of 8 +/- 4 months following ablation, 8/9 patients (89%) were in sinus rhythm. CONCLUSION: Up to one-third of post-radiofrequency MAZE circuits are typical isthmus-dependent RA flutters, despite a highly atypical surface ECG morphology. Therefore, diagnostic electrophysiological studies should commence with entrainment at the cavo-tricuspid isthmus in order to exclude typical flutter, regardless of the surface ECG appearance. Incomplete surgical lesions at the mitral and cavo-tricuspid isthmus likely predispose to the development of post-radiofrequency MAZE flutter.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
After atrial fibrillation maze surgery, macroreentrant tachycardia may depend on breaks in the surgical ablation lines that can be localized by endocardial mapping, allowing interruption by localized ablation at those sites.
“After AF 'maze' surgery, MRT may depend on breaks of the surgical ablation lines that can be localized by endocardial mapping allowing interruption of the MRT by localized ablation at these sites.201,202”
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 [201]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Modification of the maze procedure for atrial flutter and atrial fibrillation
Cox, J. L., Jaquiss, R. D. B., Schuessler, R. B., & Boineau, J. P. (1995) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(95)70245-8 · Cited by 482 · see citing works
Saoudi, N., Cosío, F., Waldo, A., Chen, S. A., Iesaka, Y., Lesh, M., Saksena, S., Salerno, J., & Schoels, W. (2001) · European Heart Journal · doi:10.1053/euhj.2001.2658 · Cited by 464 · see citing works
Damiano, R. J., Gaynor, S. L., Bailey, M. S., Prasad, S. M., Cox, J. L., Boineau, J. P., & Schuessler, R. B. (2003) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2003.07.006 · Cited by 202 · see citing works
Surface electrocardiographic characteristics of right and left atrial flutter
Bochoeyer, A., Yang, Y., Cheng, J., Lee, R. J., Keung, E. C., Marrouche, N. F., Natale, A., & Scheinman, M. M. (2003) · Circulation · doi:10.1161/01.cir.0000079140.35025.1e · Cited by 123 · see citing works
Okumura, K., Plumb, V. J., Pagé, P., & Waldo, A. L. (1991) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(10)80124-x · Cited by 121 · see citing works
Chugh, A., Latchamsetty, R., Oral, H., Elmouchi, D., Tschopp, D. R., Reich, S., Igic, P., Lemerand, T., Good, E. D., Bogun, F. M., et al. (2006) · Circulation · doi:10.1161/circulationaha.105.580936 · Cited by 114 · see citing works
Goldstein, R. N., Khrestian, C. M., Carlsson, L. G., & Waldo, A. L. (2004) · Journal of Cardiovascular Electrophysiology · doi:10.1046/j.1540-8167.2004.04354.x · Cited by 108 · see citing works
Chugh, A., Oral, H., Good, E. D., Han, J. D., Tamirisa, K. P., Lemola, K., Elmouchi, D., Tschopp, D. R., Reich, S., Igic, P., et al. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2005.03.053 · Cited by 107 · see citing works
Advances in the surgical treatment of atrial fibrillation
Gillinov, A. M., & McCarthy, P. M. (2004) · Cardiology Clinics · doi:10.1016/s0733-8651(03)00135-8 · Cited by 75 · see citing works
Variable electrocardiographic characteristics of isthmus-dependent atrial flutter
Milliez, P., Richardson, A. W., Obioha-Ngwu, O., Zimetbaum, P. J., Papageorgiou, P., & Josephson, M. E. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)02070-3 · Cited by 68 · see citing works
Mechanisms of Atrial Tachyarrhythmias Following Surgical Atrial Fibrillation Ablation
Magnano, A. R., Argenziano, M., Dizon, J. M., Vigilance, D. W., Williams, M. R., Yegen, H. A., RUETER, K., Öz, M. C., & Garan, H. (2006) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2006.00419.x · Cited by 65 · see citing works
Atrial Tachyarrhythmias After the Maze Procedure
Ishii, Y., Gleva, M. J., Gamache, M. C., Schuessler, R. B., Boineau, J. P., Bailey, M. S., & Damiano, R. J. (2004) · Circulation · doi:10.1161/01.cir.0000138400.44799.65 · Cited by 62 · see citing works
Repetitive atrial flutter as a complication of the left-sided simple maze procedure
Usui, A., Inden, Y., Mizutani, S., Takagi, Y., Akita, T., & Ueda, Y. (2002) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(02)03506-3 · Cited by 57 · see citing works
Effects of Gap Geometry on Conduction Through Discontinuous Radiofrequency Lesions
Pérez, F. J., Wood, M. A., & Schubert, C. M. (2006) · Circulation · doi:10.1161/circulationaha.105.596593 · Cited by 55 · see citing works
Deneke, T., Khargi, K., Grewe, P., Calcum, B., Laczkovics, A. M., Keyhan-Falsafi, A. M., Mügge, A., Lawo, T., & Lemke, B. (2005) · Journal of Cardiovascular Electrophysiology · doi:10.1111/j.1540-8167.2005.00265.x · Cited by 15 · see citing works
Lo, H., Lin, J.-L., Lin, F., et al. (2003) · Pacing and Clinical Electrophysiology · doi:10.1046/j.1460-9592.2003.t01-1-00282.x · Cited by 12 · see citing works
Pašić, M., Musci, M., Edelmann, B., Siniawski, H., Bergs, P., & Hetzer, R. (1999) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(99)00231-3 · Cited by 11 · see citing works
McClelland, J. H., & Duke, D. J. (2006) · Heart Rhythm · doi:10.1016/j.hrthm.2006.02.039 · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, J. C., Conti, J. B., Ellinor, P. T., Ezekowitz, M. D., Field, M. E., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.03.022 · Cited by 2,955 · see citing works
2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia
Page, R. L., Joglar, J. A., Caldwell, M. A., Calkins, H., Conti, J. B., Deal, B. J., Estes, N. A. M., Field, M. E., Goldberger, Z. D., Hammill, S. C., et al. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.08.856 · Cited by 439 · see citing works
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
- AKAR, J. G., AL‐CHEKAKIE, M. O., HAI, A., BRYSIEWICZ, N., PORTER, M., VARMA, N., SANTUCCI, P., & WILBER, D. J.
- Affiliations
- Loyola University Medical Center (US)
- Corresponding author
- AKAR, JOSEPH G.
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2007-02-21
- Volume
- 18
- Issue
- 4
- Pages
- 349-355
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2059551707
- Cited by
- 36
- References
- 18
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 2 · 2020: 2 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 6 · 2014: 3 · 2013: 1 · 2012: 4
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Cardiovascular Electrophysiology (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 electrophysiology and arrhythmias
- Keywords
- atrial flutter, postoperative arrhythmia, atrial fibrillation, cavotricuspid isthmus, mitral annulus, left atrial flutter, right atrial flutter, catheter ablation, cycle length
- MeSH terms
- Adult, Aged, Aged, 80 and over, Atrial Flutter, Combined Modality Therapy, Cryosurgery, Female, Heart Atria, Heart Valve Diseases, Humans, Male, Middle Aged, Treatment Outcome, Catheter Ablation, Body Surface Potential Mapping, Electrophysiologic Techniques, Cardiac
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
