Atrial Tachycardias Occurring Late After Open Heart Surgery

Author(s): Maria Kohari , Robert Pap .

Journal Name: Current Cardiology Reviews

Volume 11 , Issue 2 , 2015

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Graphical Abstract:


Abstract:

Atrial tachycardias are common after open heart surgery. Most commonly these are macro-reentrant including cavotricuspid isthmus dependent atrial flutter, incisional right atrial flutter and left atrial flutter. Focal atrial tachycardias occur less frequently. The specific type of atrial tachycardia highly depends on the type of surgical incision. Catheter ablation can be very effective, however requires a thorough understanding of anatomy and surgical technique.

Keywords: Atrial tachycardia, complex congenital syndromes, electroanatomical mapping, entrainment, re-entrant tachycardia, post-operative period.

[1]
Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg 1993; 56(3): 539-49.
[2]
Nakagawa H, Shah N, Matsudaira K, et al. Characterization of Reentrant Circuit in Macroreentrant Right Atrial Tachycardia After Surgical Repair of Congenital Heart Disease : Isolated Channels Between Scars Allow “Focal” Ablation. Circulation 2001; 103(5): 699-709.
[3]
Delacretaz E, Ganz LI, Soejima K, et al. Multiple atrial macro–re-entry circuits in adults with repaired congenital heart disease: entrainment mapping combined with three-dimensional electroanatomic mapping. J Am Coll Cardiol 2001; 37(6): 1665-76.
[4]
Lukac P, Hjortdal VE, Pedersen AK, Mortensen PT, Jensen HK, Hansen PS. Atrial Incision Affects the Incidence of Atrial Tachycardia After Mitral Valve Surgery. Ann Thorac Surg 2006; 81: 509-13.
[5]
Pap R, Kohári M, Makai A, et al. Surgical technique and the mechanism of atrial tachycardia late after open heart surgery. J Interv Card Electr 2012; 35(2): 127-35.
[6]
Murphy JG, Gersch BJ, Phil D, et al. Long-term outcome after surgical repair of isolated atrial septal defect. N Engl J Med 1990; 323: 1645-50.
[7]
Roubertie F, Thambo J-B, Bretonneau A, et al. Late outcome of 132 Senning procedures after 20 years of follow-up. Ann Thorac Surg 2011; 92(6): 2206-13.
[8]
Duster MC, Bink-Boelkens MT, Wampler D, Gillette PC, McNamara DG, Cooley DA. Long-term follow-up of dysrhythmias following the Mustard procedure. Am Heart J 1985; 109: 1323.
[9]
Garson A, Bink-Boelkens M, Hesslein PS, et al. Atrial flutter in the young: a collaborative study of 380 cases. J Am Coll Cardiol 1985; 6(4): 871-8.
[10]
Anné W, Van Rensburg H, Adams J, Ector H, Van de Werf F, Heidbüchel H. Ablation of post-surgical intra-atrial reentrant tachycardia. Predilection target sites and mapping approach. Eur Heart J 2002; 23(20): 1609-16.
[11]
Tomita Y, Matsuo K, Sahadevan J, Khrestian CM, Waldo AL. Role of Functional Block Extension in Lesion-Related Atrial Flutter. Circulation 2001; 103: 1025-30.
[12]
Waldo AL. Mechanisms of atrial flutter and atrial fibrillation : distinct entities or two sides of a coin? Cardiovasc Res 2002; 54: 217-29.
[13]
Lukac P, Hjortdal V, Pedersen AK, Jensen HK, Mortensen PT, Hansen PS. The Superior Transseptal Surgical Approach to Mitral Valve Creates Slow Conduction. Pace 2006; 29: 719-26.
[14]
Khairy P, Van Hare GF. Catheter ablation in transposition of the great arteries with Mustard or Senning baffles. Heart Rhythm 2009; 6(2): 283-9.
[15]
Aktas MK, Khan MN, Di Biase L, et al. Higher rate of recurrent atrial flutter and atrial fibrillation following atrial flutter ablation after cardiac surgery. J Cardiovasc Electr 2010; 21(7): 760-5.
[16]
Jaïs P, Shah DC, Haïssaguerre M, et al. Mapping and Ablation of Left Atrial Flutters. Circulation 2000; 101: 2928-34.
[17]
Ouyang F, Ernst S, Vogtmann T, et al. Characterization of Reentrant Circuits in Left Atrial Macroreentrant Tachycardia: Critical Isthmus Block Can Prevent Atrial Tachycardia Recurrence. Circulation 2002; 105: 1934-42.
[18]
De Groot NMS, Zeppenfeld K, Wijffels MC, et al. Ablation of focal atrial arrhythmia in patients with congenital heart defects after surgery: role of circumscribed areas with heterogeneous conduction. Heart Rhythm 2006; 3(5): 526-35.
[19]
Chen S, Tai C, Chiang C, Ding Y, Chang M. Focal Atrial Tachycardia : Reanalysis of the Clinical and Electrophysiologic Characteristics and Prediction of Successful Radiofrequency Ablation. J Cardiovasc Electr 1998; 9: 355-65.
[20]
Lukac P, Pedersen AK, Mortensen PT, Jensen HK, Hjortdal V, Hansen PS. Ablation of atrial tachycardia after surgery for congenital and acquired heart disease using an electroanatomic mapping system: Which circuits to expect in which substrate? Heart Rhythm 2005; 2(1): 64-72.
[21]
Natale A, Newby KH, Pisanó E, et al. Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. J Am Coll Cardiol 2000; 35(7): 1898-904.
[22]
Babaev A, Suma V, Tita C, Steinberg JS. Recurrence Rate of Atrial Flutter After Initial Presentation in Patients on Drug Treatment. Am J Cardiol 2003; 92: 1122-4.
[23]
Gavaghan TP, Koegh AM, Kelly RP, Campbell TJ, Thorburn C, Morgan JJ. Flecainide compared with a combination of digoxin and disopyramide for acute atrial arrhythmias after cardiopulmonary bypass. Br Heart J 1988; 60(6): 497-501.
[24]
Miyazaki H, Stevenson WG, Stephenson K, Soejima K, Epstein LM. Entrainment mapping for rapid distinction of left and right atrial tachycardias. Heart Rhythm 2006; 3: 516-23.
[25]
Roberts-Thomson KC, Kalman JM. Right septal macroreentrant tachycardia late after mitral valve repair: Importance of surgical access approach. Heart Rhythm 2007; 4: 32-6.
[26]
Snowdon RL, Balasubramaniam R, Teh AW, et al. Linear Ablation of Right Atrial Free Wall Flutter : Demonstration of Bidirectional Conduction Block as an Endpoint Associated With Long-Term Success. J Cardiovasc Electr 2010; 21: 526-31.
[27]
Magnin-Poull I. Chillou CDe, Miljoen H, Andronache M, Aliot E. Mechanisms of Right Atrial Tachycardia Occurring Late After Surgical Closure of Atrial Septal Defects. J Cardiovasc Electr 2005; 16: 681-7.
[28]
Seiler J, Schmid DK, Irtel TA, et al. Dual-loop circuits in postoperative atrial macro re-entrant tachycardias. Heart 2007; 93: 325-30.
[29]
Singh SM, Neuzil P, Skoka J, et al. Percutaneous transhepatic venous access for catheter ablation procedures in patients with interruption of the inferior vena cava. Circ Arrhythm Electrophysiol 2011; 4: 235-41.
[30]
De Groot NMS, Atary JZ, Blom NA, Schalij MJ. Long-term outcome after ablative therapy of postoperative atrial tachyarrhythmia in patients with congenital heart disease and characteristics of atrial tachyarrhythmia recurrences. Circ Arrhythm Electrophysiol 2010; 3: 148-54.
[31]
Dave AS, Aboulhosn J, Child JS, Shivkumar K. Transconduit puncture for catheter ablation of atrial tachycardia in a patient with extra-cardiac Fontan palliation. Heart Rhythm 2010; 7(3): 413-6.


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Article Details

VOLUME: 11
ISSUE: 2
Year: 2015
Page: [134 - 140]
Pages: 7
DOI: 10.2174/1573403X10666141013122021
Price: $58

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