Surgical technique and the mechanism of atrial tachycardia late after open heart surgery

摘要

Introduction: Diverse atrial tachycardias (ATs) can develop after open heart surgery. The aim of our study was to examine the determinants of the mechanism of postoperative AT. Methods and results: One hundred patients with AT occurring at least 3 months after open heart surgery were studied. Patients were grouped according to the atrial incision applied at the time of surgery. During 127 electrophysiology procedures, 151 ATs were studied. Eighty-eight patients had cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL), 49 patients had at least one non-CTI-dependent AFL and 11 patients had focal AT. While CTI-dependent AFL was equally prevalent across groups, the finding of a non-CTIdependent AFL was progressively more common as more extensive atriotomy was applied (p<0.001). Among patients who had right atrial (RA) operations, RA incisional tachycardia was the most common non-CTI-dependent circuit, while the finding of perimitral or left atrial (LA) roofdependent AFL was associated with LA atriotomy (p=0.002 and p=0.041, respectively). After adjustment for possible confounders, surgical group remained independent predictor of non-CTI-dependent AFLs (p<0.001). No predictor was identified for focal AT, which originated from typical predilection sites and in 36% from the vicinity of surgical scar. Radiofrequency ablation was highly effective for all ATs, but the recurrence rate of AFL and atrial fibrillation was high at 22% and 27%, respectively, during 19±15 months of follow-up. Conclusion: While CTI-dependent AFL is the most common AT late after open heart surgery, atypical AFL becomes progressively more common with more extensive atriotomy. Right atrial incisional tachycardia is the dominant non-CTIdependent AFL after opening of the RA, while a perimitral or roof-dependent LA circuit can be expected after LA operations.