[Radical surgical treatment of atrial flutter]

From January 1983 to May 1992 a total of 40 patients with a tachysystolic type of atrial flutter (AF) refractory to preventive antiarrhythmic therapy were examined and operated on. The obligatory stage of a preoperative examination was invasive phonoelectrocardiography. The effects of "entrainment" and adaptation of refractory periods of various portions of atria were estimated depending on the duration of a basic stimulation cycle. In inducing a AF paroxysm, the site of early A spike appearance was determined and endomyocardial mapping was performed. During intraoperative mapping, the data on low-amplitude and fragmented activity were processed by a computer. The sequence of the electric activation of the atria in AF was also determined. Twenty seven transthoracic operations were performed via extracorporeal circulation, 9 of them underwent laser or cryogenic isolation of the atrioventricular node, 4 laser photo ablation, 10 cryodestruction of arrhythmogenic areas. Resection of 1/3 of the marginal crust, sinoatrial node with subsequent implantation of a pacemaker was made in 1 patient in the AA1 mode. Three patients underwent operation to create a labyrinth by J. Cox and a corridor by J. Quiraudon. The closed heart operations involved both transvenous electrodestruction of arrhythmogenic areas (5 patients) and destruction of the His bundle with developed complete block and pacemaker implantation in the VVI mode (8 patients). The best results of surgical treatment were obtained in young patients with idiopathic AF (Type 1), when the areas of fragmented and low-amplitude activity could be accurately determined.