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- Title
Surface Electrocardiographic Patterns and Electrophysiologic Characteristics of Atrial Flutter Following Modified Radiofrequency MAZE Procedures.
- Authors
AKAR, JOSEPH G.; AL‐CHEKAKIE, M. OBADAH; HAI, AFROZ; BRYSIEWICZ, NEIL; PORTER, MICHAEL; VARMA, NIRAJ; SANTUCCI, PETER; WILBER, DAVID J.
- Abstract
Introduction: The radiofrequency MAZE is becoming a common adjunct to cardiac surgery in patients with atrial fibrillation. While a variety of postoperative arrhythmias have been described following the original Cox-MAZE III procedure, the electrophysiological characteristics and surgical substrate of post-radiofrequency MAZE flutter have not been correlated. We sought to determine the location, ECG patterns, and electrophysiological characteristics of post-radiofrequency MAZE atrial flutter. Methods: Nine consecutive patients with post-radiofrequency MAZE flutter presented for catheter ablation 9 ± 10 months after surgery. Results: Only one patient (11%) had an ECG appearance consistent with typical isthmus-dependent right atrial (RA) flutter. However, on electrophysiological study, 3/9 patients (33%) had typical right counter-clockwise flutter entrained from the cavo-tricuspid isthmus, despite description of surgical isthmus ablation. Six patients (67%) had left atrial (LA) circuits. These involved the mitral annulus in 5/6 cases (83%) despite description of surgical mitral isthmus ablation in the majority (60%). LA flutters had a shorter cycle length compared with RA flutters (253 ± 39 msec and 332 ± 63 msec respectively, P < 0.05). After a mean of 8 ± 4 months following ablation, 8/9 patients (89%) were in sinus rhythm. Conclusion: Up to one-third of post-radiofrequency MAZE circuits are typical isthmus-dependent RA flutters, despite a highly atypical surface ECG morphology. Therefore, diagnostic electrophysiological studies should commence with entrainment at the cavo-tricuspid isthmus in order to exclude typical flutter, regardless of the surface ECG appearance. Incomplete surgical lesions at the mitral and cavo-tricuspid isthmus likely predispose to the development of post-radiofrequency MAZE flutter.
- Subjects
RADIO frequency; CARDIAC surgery; ATRIAL fibrillation; ARRHYTHMIA; ELECTROCARDIOGRAPHY; CATHETER ablation
- Publication
Journal of Cardiovascular Electrophysiology, 2007, Vol 18, Issue 4, p349
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/j.1540-8167.2007.00761.x