Repetitive atrial flutter as a complication of the left-sided simple maze procedure.
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.
Usui
Akihiko
A
Department of Cardio-Thoracic Surgery, Nagoya University Graduate School of Medicine, Japan. ausui@med.nagoya-u.ac.jp
Inden
Yasuya
Y
Mizutani
Shinichi
S
Takagi
Yasushi
Y
Akita
Toshiaki
T
Ueda
Yuichi
Y
D000328:Adult; D001281:Atrial Fibrillation / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D003452:Cryosurgery; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000601:surgery; D013536:Suture Techniques