Catheter ablation of atrial tachyarrhythmias after a Maze procedure: A single center experience. Issue 3 (March 2019)

• Record Type: Journal Article
• Authors: Kajiyama, Takatsugu; Kondo, Yusuke; Ueda, Marehiko; Nakano, Masahiro; Nakano, Miyo; Watanabe, Michiko; Matsumiya, Goro; Kobayashi, Yoshio
• Is Part Of: Journal of cardiology cases. Volume 19:Issue 3(2019)
• Page Start: 89
• Page End: 92
• Publication Date: 2019-03
• Subjects: Atrial fibrillation -- Atrial tachycardia -- Catheter ablation -- Maze procedure -- Pulmonary vein isolation; Cardiology -- Periodicals; Cardiovascular Diseases -- Case Reports; Cardiovascular Diseases -- Periodicals; Cardiology -- Case Reports; Cardiology -- Periodicals; Cardiology; Electronic journals; Periodicals; 616.12
• DOI: 10.1016/j.jccase.2018.12.003
• Languages: English
• ISSNs: 1878-5409

Abstract

Abstract: Significant recurrence of atrial tachyarrhythmias are observed after the surgical Cox Maze procedure (CMP). We retrospectively enrolled 11 consecutive patients who had atrial tachyarrhythmias (ATAs) that recurred after a biatrial CMP and underwent catheter ablation. Information including the site of any incomplete lesions and the etiology of the clinical ATAs was shared with the surgical team as feedback. In a total of 11 patients, 12 clinical ATAs were identified. They consisted of 2 atrial fibrillations and 10 atrial tachycardias (ATs). In 6 patients, the CMP was performed after the beginning of this investigation. In a total of 10 ATs, we diagnosed 5 mitral annular flutters, 2 roof-dependent flutters, 1 pulmonary vein (PV)-reentrant AT, and 1 localized reentrant AT. A total of 6 patients had reconnected perimitral block lines. PV reconnections were observed in 3 and posterior wall (PW) residual conduction was also observed in 3 cases. However, no residual conduction of the pulmonary vein isolation (PVI) and only 1 residual conduction of the PW were observed in 5 patients who underwent their index surgery after the beginning of this investigation. This fact may implicate that sharing the information from the electrophysiological study of postsurgical ATAs with the surgical team may contribute to the refinement of the CMP in each facility. <Learning objective: Reconduction of the surgical lesion is the major etiology of recurrence of atrial tachyarrhythmias after the surgical Cox Maze procedure. Although perimitral block line seemed to be the most frequent reconduction site, our study suggested that durable lesion of the PVI and the PW isolation could be achieved by improving surgical techniques by feedback from the electrophysiological team to the surgical team.>