Proarrhythmic Aspects of Atrial Fibrillation Surgery: Mechanisms of Postoperative Macroreentrant Tachycardias
Abstract
BACKGROUND: Surgery for the treatment of atrial fibrillation may be associated with early or late postoperative atrial arrhythmias. In many cases, the arrhythmias that occur early in the postoperative course may be related to pericardial inflammation or increased catecholamine levels and tend to resolve without further therapy. In contrast, late postoperative arrhythmias often are persistent, highly symptomatic, and refractory to medical therapy. The incidence and mechanisms of these late atrial arrhythmias have not been thoroughly described. METHODS AND RESULTS: In this study, a total of 143 consecutive patients undergoing atrial fibrillation surgery from 1996 to 2005 were prospectively followed up. Sustained atrial tachycardia developed in 22 of 143 patients (15%) >8 weeks after the surgical procedure. These patients underwent electrophysiological study. A total of 25 separate tachycardias were mapped in these 22 patients, including 15 located in right atrium and 10 in the left atrium. Right atrial tachycardias included cavotricuspid isthmus-dependent atrial flutter (n=7), non-isthmus-dependent right atrial reentry (n=7), and 1 focal atrial tachycardia. Left atrial tachycardias included reentry around the mitral valve (n=3) and in the roof of the left atrium (n=7). All tachycardias were successfully treated with radiofrequency catheter ablation with no recurrences in long-term follow-up. CONCLUSIONS: Postoperative arrhythmias are not uncommon late after surgery for atrial fibrillation and typically are reentrant and related to surgically created boundaries. Radiofrequency catheter ablation is highly effective in the management of these late arrhythmias.
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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 [202]
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Nonpharmacologic Treatment of Tachyarrhythmias
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Ablation of Nonisthmus-Dependent Flutters and Atrial Macroreentry
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Catheter ablation is preferred over surgery for persistent atrial fibrillation
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Surgical Atrial Fibrillation Ablation
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Ablation of Non–Isthmus-Dependent Flutters and Atrial Macro-Reentry
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Ablation of Non–Isthmus-Dependent Flutters and Atrial Macroreentry
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- Authors
- McElderry, H. T., McGiffin, D. C., Plumb, V. J., Nanthakumar, K., Epstein, A. E., Yamada, T., & Kay, G. N.
- Affiliations
- University of Alabama at Birmingham (US)
- Venue
- Circulation
- Published
- 2008-01-15
- Volume
- 117
- Issue
- 2
- Pages
- 155-162
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2117904030
- Cited by
- 62
- References
- 32
- Citations by year
- 2025: 1 · 2024: 6 · 2023: 2 · 2022: 1 · 2021: 6 · 2020: 2 · 2019: 6 · 2018: 3 · 2017: 9 · 2016: 3 · 2015: 7 · 2014: 3 · 2012: 5
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation surgery, postoperative atrial arrhythmia, drug-induced arrhythmia, atrial tachycardia, atrial flutter, reentrant tachycardia, radiofrequency catheter ablation, electrophysiological mapping, left atrial tachycardia, right atrial tachycardia
- MeSH terms
- Adult, Aged, Arrhythmias, Cardiac, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Postoperative Complications, Prospective Studies, Tachycardia, Time Factors, Catheter Ablation, Body Surface Potential Mapping
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