Share this page on LinkedIn
Share This Page on Google+
Share This Page on Twitter
tell someone about this page print this page
You are here: Contents > 2016 > Volume 25 Number 5 September 2016 > AORTIC VALVE DISEASE > Ablation of Macro-Re-Entrant Atrial Arrhythmia Late after Surgical Aortic Valve Replacement

Ablation of Macro-Re-Entrant Atrial Arrhythmia Late after Surgical Aortic Valve Replacement

Michał Orczykowski1, Paweł Derejko1,3, Piotr Urbanek1, Robert Bodalski1, Katarzyna Kodziszewska2, Radosław Sierpiński1, Rafał Baranowski1, Maria Bilińska1, Łukasz Szumowski1

1Arrhythmia Department, National Institute of Cardiology, Warsaw
2Heart Failure Department, National Institute of Cardiology, Warsaw
3Medicover Hospital, Cardiology Department, Warsaw, Poland
4Electronic correspondence: morczykowski@gazeta.pl

Background and aim of the study: Re-entrant atrial arrhythmias are common in patients after cardiac surgery. To date, however, no studies have reported the safety and efficacy of radiofrequency (RF) ablation of macro-re-entrant atrial arrhythmias in a unique, homogeneous group of patients after surgical replacement of the aortic valve and single right atriotomy.

Methods: Among over 4,000 RF catheter ablations performed at the authors’ center between 2008 and 2014, eight patients (seven males, one female; mean age 55.1 ± 19.9 years) after aortic valve replacement (AVR) and without history of any other cardiosurgical procedures were identified with documented macro-re-entrant atrial arrhythmia. The mechanism of macro-re-entrant arrhythmia was analyzed, as well as the safety and efficacy of RF ablation in a group of patients after AVR and single right atrial free wall atriotomy.

Results: The average time from surgery to RF catheter ablation was 11.3 ± 11.3 years (range: 4-35 years). In five patients with permanent arrhythmia, entrainment mapping proved these arrhythmias to be cavotricuspid isthmus-

dependent, in three patients with paroxysmal atrial arrhythmia cavotricuspid isthmus-dependent atrial flutter was induced during the electrophysiological study. Intra-atrial re-entrant tachycardia was neither recorded nor induced in any patient. Successful ablation of cavotricuspid isthmus is defined as the termination of arrhythmia, and bidirectional block in cavotricuspid isthmus was achieved in all patients. A long-term follow up, based on a seven-day Holter monitoring, was conducted in all patients, with a mean observation time of 40.1 ± 28.6 months after the procedure. Among the patients, ablated arrhythmia (cavotricuspid isthmusdependent atrial flutter) recurred in one patient, atrial fibrillation occurred in three patients, and an atrial tachycardia in one patient.

Conclusion: In the presented series of patients, cavotricuspid isthmus-dependent atrial flutter was shown to be the mechanism of post-cardiosurgical macro-re-entrant clinical arrhythmia in all subjects. Atrial fibrillation was frequently observed among those patients during follow up.

The Journal of Heart Valve Disease 2016;25:574-579


Ablation of Macro-Re-Entrant Atrial Arrhythmia Late after Surgical Aortic Valve Replacement

Click the above hyperlink to view the article, right click (Ctrl click on a Mac) to open in a new browser window or tab.

Purchase this Article

Please click the button below to purchase this article. Single article purchases are provided at $50.00 per article. Upon clicking the button below, single article user account subscription details are requested and, upon successful payment, a single article user account is created. Single articles are availble in your account for seven days after purchase.