Atrial Arrhythmias Following Surgical AF Ablation: Electrophysiological Findings, Ablation Strategies, and Clinical Outcome
Abstract
BACKGROUND: Intraoperative atrial fibrillation (AF) ablation during cardiac surgery is a well-established treatment. However, tachycardia mechanisms, ablation strategies, and long-term follow-up of atrial arrhythmias (AA) following intraoperative AF ablation (AFA) have not been previously studied in a large cohort of patients. OBJECTIVE: Eighty-two patients (48 male, median age of 65 years) with symptomatic recurrence of AA following intraoperative AFA underwent radiofrequency catheter ablation. METHODS: Regular atrial tachycardias (AT) were mapped using 3-dimensional (3D) color-coded entrainment/activation mapping and eliminated by linear ablation. Pulmonary vein (PV)-isolation (PVI) was achieved in patients with left atrium-PV (LAPV) conduction after AT elimination. RESULTS: In 85 (83%) out of a total of 103 regular ATs, the entire reentrant circuits were localized perimitrally (n = 27), around PVs (left PV [LPV] or right PV [RPV]; n = 9), around left atrial appendage (LAA; n = 1), on left-sided atrial septum (n = 8), on atrioventricular nodal area (n = 1), on the posterior wall of LA (n = 1), along roof-septum-inferoposterior wall (n = 8), at coronary sinus ostium (n = 2), upper loop in RA (n = 1), and as cavotricuspid isthmus-dependent reentrant ATs (n = 27). Sixty-five (79%) patients received PVI. Noninducibility of any AT was reached at the end of all procedures. During a median follow-up time of 18 months, 69 patients (87%) were free of AA. CONCLUSION: Reentrant AT appears in the majority of patients with recurrence of AA following intraoperative AFA. Detailed 3D color-coded entrainment mapping was successfully obtained in the majority of patients suffering from reentrant AT after intraoperative AFA, facilitated the accurate identification of the entire reentrant circuit and selection of optimal ablation lines.
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Catheter ablation of left atrial macroreentrant tachycardia is more complex, with lower success rates and higher recurrence rates.
“Catheter ablation of left atrial macroreentrant tachycardia is more complex, with lower success rates and higher recurrence rates.1006,1007”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [1007]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- HUO, Y., SCHOENBAUER, R., RICHTER, S., ROLF, S., SOMMER, P., ARYA, A., RASTAN, A., DOLL, N., MOHR, F., HINDRICKS, G., PIORKOWSKI, C., & GASPAR, T.
- Affiliations
- Herzzentrum Dresden Universitätsklinik (DE)
- Department of Electrophysiology Leipzig University—Heart Center Leipzig Germany
- Leipzig Heart Institute (DE)
- Department of Cardiac Surgery Rotenburg a. d. Fulda Germany
- Department of Cardiac Surgery Sana Hospital Stuttgart Germany
- Corresponding author
- PIORKOWSKI, CHRISTOPHER
- ORCID
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2014-04-02
- Volume
- 25
- Issue
- 7
- Pages
- 725-738
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2132510727
- Cited by
- 45
- References
- 32
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 6 · 2021: 2 · 2020: 5 · 2019: 5 · 2018: 2 · 2017: 4 · 2016: 5 · 2015: 6 · 2014: 1
- FWCI
- 3.66
- Type
- journal article
- Language
- en
- Open access
- closed
- 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 arrhythmias, atrial tachycardia, reentrant circuit, pulmonary vein isolation, radiofrequency catheter ablation, interatrial septum, coronary sinus ostium, cavotricuspid isthmus, atrial fibrillation recurrence, cardiac surgery
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Atrial Flutter, Female, Cardiac Surgical Procedures, Humans, Image Interpretation, Computer-Assisted, Intraoperative Care, Male, Middle Aged, Pulmonary Veins, Recurrence, Retrospective Studies, Tachycardia, Supraventricular, Time Factors, Treatment Outcome, Catheter Ablation, Imaging, Three-Dimensional, Electrophysiologic Techniques, Cardiac
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