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Repetitive atrial flutter as a complication of the left-sided simple maze procedure
Akihiko Usui1, Yasuya Inden, Shinichi Mizutani
1Department of Cardio-Thoracic Surgery, Nagoya University Graduate School of Medicine, Japan. ausui@med.nagoya-u.ac.jp
Background:
Of 41 patients who had undergone a left-sided simple maze procedure, 4 (9.8%) developed repetitive tachycardia due to atrial flutter, and required radiofrequency catheter ablation. Linear ablation of the right atrial isthmus was effective to treat atrial flutter.
Methods:
We conducted an electrophysiologic study of atrial flutter and determined its reentry circuit on the atrium. We consider how to reduce atrial flutter after the left-sided simple maze procedure.
Results:
Common atrial flutter through the right atrial isthmus was induced in all 4 patients, and linear ablation on the right atrial isthmus was effective in 3 of these. An incisional atrial flutter around the right atriotomy was also induced in 2 of 4 patients; both were successfully treated by linear ablation between the right atriotomy and the inferior vena cava.
Conclusions:
Common atrial flutter through the right atrial isthmus is a risk after the left-sided simple maze procedure. When a left-sided simple maze procedure is performed, sufficient cryoablation on the right atrial isthmus of the arrested heart should be administered to prevent postoperative atrial flutter.