Atrial Tachyarrhythmias After the Maze Procedure

Ishii, Yôsuke; Gleva, Marye J.; Gamache, M. Carolyn; Schuessler, Richard B.; Boineau, John P.; Bailey, Marci S.; Damiano, Ralph J.

doi:10.1161/01.cir.0000138400.44799.65

Cited by 42 publications

(26 citation statements)

References 30 publications

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“…30 Nevertheless, early postoperative atrial tachyarrhythmias are often transient and usually terminate within the first several weeks after surgery. 31 …”

Section: Effect Of Concurrent Maze Operation On Maintenance Of Srmentioning

confidence: 99%

Fate of Preoperative Atrial Fibrillation After Correction of Atrial Septal Defect

Choi

Shim

et al. 2013

Circ J

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“…30 Nevertheless, early postoperative atrial tachyarrhythmias are often transient and usually terminate within the first several weeks after surgery. 31 …”

Section: Effect Of Concurrent Maze Operation On Maintenance Of Srmentioning

confidence: 99%

Fate of Preoperative Atrial Fibrillation After Correction of Atrial Septal Defect

Choi

Shim

et al. 2013

Circ J

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“…23 Thus, discharge in AF is not an indication of procedure failure. 39 Factors that influence procedure success include larger left atrial size, longer duration of AF, and choice of lesion set in permanent AF. 40,41 The development of new techniques and operations for surgical treatment of AF has caused a change in cardiac surgical practice.…”

Section: Gillinov Surgical Treatment Of Atrial Fibrillationmentioning

confidence: 99%

Advances in Surgical Treatment of Atrial Fibrillation

Gillinov

2007

Stroke

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Abstract-Atrial fibrillation (AF) is the most common sustained arrhythmia. It is associated with increased risks of death and stroke; most strokes in AF patients are thought to arise from thrombi in the left atrial appendage. Surgical ablation of AF includes excision of the left atrial appendage and is an effective means of treating this arrhythmia, with the classic Maze procedure curing AF in Ͼ90% of patients and virtually eliminating the risk of late stroke. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. Americans; this number is expected to increase to Ͼ5.6 million by 2050. 1 The prevalence of AF increases with increasing patient age, and recent data from the Framingham Heart Study suggest that the lifetime risks for development of AF are 1 in 4 for men and women aged Ն40 years. 2 This epidemic has a growing impact on the healthcare system and a multibillion dollar cost. The clinical consequences of AF are well documented. AF is associated with reduced life expectancy and increases the risk of stroke 5-fold, accounting for Ϸ15% of all strokes nationally. 3-8 These AF-related strokes are a major challenge and a focus of several clinical trials investigating strategies for primary and secondary prevention. 4 Currently, antithrombotic therapy is the mainstay for stroke prevention in AF patients.Although there is currently some consensus concerning pharmacological strategies for stroke prevention in AF patients, choice of therapy for the heart rhythm is controversial and evolving. 9,10 Available antiarrhythmic therapies inconsistently restore sinus rhythm and are associated with complications. In fact, the risks associated with antiarrhythmic drug therapy may counterbalance the potential benefit of restoration of sinus rhythm. 9,10 These observations, coupled with increased understanding of the pathogenesis of AF, have resulted in the development of interventional strategies to restore sinus rhythm. Both catheter-based and surgical approaches have demonstrated effectiveness in this regard. Developed by Dr James Cox, the classic Maze procedure is the predicate operation for ablation of AF; long-term data suggest that the Maze procedure eliminates AF in Ͼ90% of patients. 11-14 Despite these unmatched results, the complexity and time associated with the Maze procedure have prevented widespread application by surgeons.Recently, however, there has been increased interest in direct surgical ablation of AF, fueled by technological advances and demonstration that the pulmonary veins and left atrium are the drivers of AF in most patients. 15 New ablation technologies enable surgeons to perform pulmonary vein isolation, create strategically placed, linear left atrial lesions, and excise the left atrial appendage rapidly and safely. 16 -23 Alternate energy sources used to create lines of conduction block and replace surgical incisions of the Maze procedure include radiofrequency, microwave, ultrasound, cryothermy, and laser. 16 -25 Applied primarily in patients with valvular...

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“…The strongest preoperative predictors of the development of recurrent ATA following the CMP are patient age and left atrial size. 1 Younger individuals are at greater risk of developing recurrent ATA than those patients who are older (p ¼ 0.0093). 7 Increases in left atrial diameter were also associated with a greater risk of recurrence, with an odds ratio of 1.42 (p ¼ 0.027).…”

Section: Discussionmentioning

confidence: 98%

“…Ishii et al reported that only 14% of recurrent ATAs were due to AFL, while Trumello et al reported that CTI-dependent flutter occurred in less than 8% of cases studied. 1,8 Furthermore, incomplete or non-transmural radiofrequency lesions are pro-arrhythmic and predispose the patient to reentrant circuits. In the single-center studies conducted by Chun et al and Ouyang et al, respectively, restored pulmonary vein conduction and failure to sufficiently isolate the pulmonary veins were the primary sources of recurrent ATA.…”

Section: Discussionmentioning

confidence: 99%

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An Atypical Presentation of Right Atrial Flutter Following the Cox Maze Procedure and Left Atrial Reduction Surgery: A Case Report

Cheema¹,

Perzanowski

2017

JICRM

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ABSTRACT. The onset of recurrent atrial tachyarrhythmia (ATA) following the Cox maze procedure (CMP) is commonly encountered, and may be associated with increased perioperative mortality. The majority of recurrent ATA cases are localized to the left atrium following surgical ablation. Right atrial flutter (AFL) following the CMP is a less-frequent occurrence, and may pose a diagnostic challenge due to uncharacteristic surface electrocardiogram (ECG) and intracardiac activation patterns. In this case, a 68-year-old male who had previously undergone left-sided surgical ablation with left atrial reduction for the treatment of persistent atrial fibrillation during coronary artery bypass and mitral valve repair developed symptomatic atypical AFL. The patient was intolerant to amiodarone, and was thus scheduled for ablation. Given the patient's history of extensive left atrial instrumentation and surface ECG findings indicating an atypical AFL, the decision was made to proceed with left atrial mapping. During the electrophysiology study, initial activation mapping was not suggestive of a cavotricuspid isthmus reentrant arrhythmia. Here, we describe the possible mapping pitfalls associated with a persistent tachyarrhythmia that was ultimately proven to be a right AFL, despite atypical activation patterns.

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Atrial Tachyarrhythmias After the Maze Procedure

Abstract: Background-The Maze procedure restores normal sinus rhythm in the majority of patients. However, atrial tachyarrhythmias (ATA) are a common early complication after the operation. The purpose of this study was to define the incidence and natural history of ATA after the Maze procedure.

Cited by 42 publications

References 30 publications

Fate of Preoperative Atrial Fibrillation After Correction of Atrial Septal Defect

Fate of Preoperative Atrial Fibrillation After Correction of Atrial Septal Defect

Advances in Surgical Treatment of Atrial Fibrillation

An Atypical Presentation of Right Atrial Flutter Following the Cox Maze Procedure and Left Atrial Reduction Surgery: A Case Report

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