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[A case report of the maze procedure with mitral valve replacement]
1Department of Cardiovascular Surgery, Shizuoka Red Cross Hospital, Japan.
Insights
This study details a rare case of atrial flutter post-mitral valve surgery. Temporary atrial pacing leads aided diagnosis, and the patient achieved sustained sinus rhythm without antiarrhythmic drugs.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Simultaneous maze procedure and mitral valve replacement for atrial fibrillation and mitral stenosis.
- Patient presented with atrial fibrillation and mitral stenosis.
Observation:
- Sudden cardiac deterioration on postoperative day 1 due to rapid heartbeat, diagnosed as 1:1 AV conduction of atrial flutter.
- Initial difficulty in diagnosing rapid heartbeat via 12-lead ECG due to unclear P waves.
- Temporary atrial pacing leads proved crucial for diagnosing atrial flutter.
Findings:
- Atrial flutter initially responded to verapamil, converting to 2:1 conduction.
- Sustained sinus rhythm was achieved by postoperative day 13, persisting for 12 months.
- Electrophysiological examination confirmed normal sinus node function and inability to induce atrial flutter or fibrillation.
Implications:
- Highlights the diagnostic utility of temporary atrial pacing leads in complex cardiac surgeries.
- Demonstrates successful management of postoperative atrial flutter, leading to long-term sinus rhythm.
- Suggests potential for improved outcomes in patients undergoing combined cardiac procedures.
Abstract:
The maze procedure was performed simultaneously with mitral valve replacement for atrial fibrillation and mitral stenosis in a 66-year-old female. On the first postoperative day, the cardiac status deteriorated suddenly due to a very rapid heartbeat which was later diagnosed as a 1:1 AV conduction of atrial flutter. The atrial flutter responded to an injection of verapamil and changed to a 2:1 conduction. Although atrial flutter had continued until the thirteenth postoperative day, the heart achieved sinus rhythm on that day. Since then it has continued without any antiarrhythmic drugs except digitalis. It was difficult to make a diagnosis of the rapid heartbeat on the 12-lead ECG because P waves could not be seen clearly on the ECG. Recording the electrical cardiac status by using the temporal atrial pacing leads, which were placed during the operation, was helpful in diagnosing the heartbeat as atrial flutter. The electrophysiological examination eight weeks after the operation revealed that the sinus node function was normal and atrial flutter or atrial fibrillation could not be induced. The patient is well and in sinus rhythm 12 months after the operation.