Characteristics, Mechanism and Long-Term Ablation Outcome of Atrial Tachycardias After Mitral Valvular Surgery and Concomitant Cox-MAZE IV Procedure

• Published in: International Heart Journal Vol. 60; no. 1; pp. 71 - 77
• Main Authors: Zhan, Xian-zhang, Liu, Fang-zhou, Guo, Hui-ming, Liao, Hong-tao, Fang, Xian-hong, Liu, Jian, Deng, Hai, Huang, Huan-lei, Hai, Jo-jo, Tse, Hung-fat, Li, Yang-qiu, Xue, Yu-mei, Wu, Shu-lin
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 31.01.2019; Japan Science and Technology Agency
• Subjects: Ablation; Adult; Aged; Arrhythmia; Cardiac Surgical Procedures - adverse effects; Catheter Ablation; Electrocardiography; Epicardial Mapping - instrumentation; Female; Follow-Up Studies; Heart Rate; Humans; Incidence; Male; Middle Aged; Mitral Valve - physiopathology; Mitral Valve - surgery; Rheumatic; Rheumatic Heart Disease - physiopathology; Rheumatic Heart Disease - surgery; Surgery; Tachycardia; Tachycardia, Ectopic Atrial - epidemiology; Tachycardia, Ectopic Atrial - etiology; Tachycardia, Ectopic Atrial - physiopathology; Tachycardia, Ectopic Atrial - surgery; Treatment Outcome; Rheumatic
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.18-117

The incidence of atrial tachycardia (AT) after rheumatic mitral valvular (RMV) surgery has been well described. However, there have been few reports on the characteristics, mechanism, and long-term ablation outcome of ATs after RMV surgery and concomitant Cox-MAZE IV procedure.The present study reviewed consecutive patients who underwent AT ablation between May 2008 and July 2013. All patients were refractory to antiarrhythmic drugs (AADs) and had a history of RMV surgery and Cox-MAZE IV procedure. A total of 34 patients underwent AT ablation after RMV surgery and concomitant Cox-MAZE IV procedure, and presented 57 mappable and 2 unmappable ATs. The 57 mappable ATs included 14 focal-ATs and 43 reentry-ATs. Ten of the 14 focal-like ATs were located at the pulmonary vein (PV) antrum and border of a box lesion. Of the 43 reentry-ATs, 16 were marco-reentrant around the mitral annulus (MA) and 16 around the tricuspid annulus. There were 41 atypical ATs (non-cavotricuspid isthmus related) including 16 ATs related to the box lesion and 21 ATs related to other Cox-MAZE IV lesions. The AT were successfully terminated in 33 (97.1%) patients. After mean follow-up of 46.9 ± 15.7 months, 25 (73.5%) patients maintained sinus rhythm without AADs after a single procedure and 28 (82.4%) patients after repeated procedures.The recurrent ATs after RMV surgery and concomitant Cox-MAZE IV were mainly reentry mechanism, and largely related to LA. An incomplete lesion or re-conductive gaps in a prior lesion might be the predominant mechanisms for these ATs. Catheter-based mapping and ablation of these ATs seems to be effective and safe during a long-term follow-up.