title: Stable secondary arrhythmias late after intraoperative radiofrequency ablation of atrial fibrillation: incidence, mechanism, and treatment.
abstract: BACKGROUND
  Intraoperative radiofrequency (RF) ablation is an effective treatment of atrial fibrillation (AF). However, secondary arrhythmias late after ablation may complicate the patient's course. We report on the incidence, mechanisms, and treatment of gap-related atrial flutter and other secondary arrhythmias during long-term follow-up.
  
  
  RESULTS
  In 129 patients who underwent intraoperative RF ablation with placement of left atrial linear lesions using minimally invasive surgical techniques, secondary arrhythmias were analyzed during long-term follow-up (20 +/- 6 months). Transient atrial arrhythmias during the first 3 postoperative months were excluded. In 8 (6.2%) of 129 patients, sustained stable secondary arrhythmias were documented. Left atrial, gap-related atrial flutter was observed in 4 patients (3.1%). The flutter was treated by percutaneous RF ablation in 3 patients (2.3%) and with drugs in 1 patient (0.8%). In 2 patients (1.6%), right atrial isthmus-dependent atrial flutter occurred and was treated successfully by percutaneous RF ablation. In 2 patients (1.6%), ectopic right atrial tachycardias occurred and were treated with percutaneous RF ablation.
  
  
  CONCLUSIONS
  Late after intraoperative RF ablation of atrial fibrillation, three types of stable secondary arrhythmias were observed in 6% of patients: left atrial gap-related atrial flutter, right atrial isthmus-dependent atrial flutter, and ectopic atrial tachycardia. Gaps after intraoperative RF ablation due to noncontinuous or nontransmural linear lesions may lead to stable left atrial macroreentrant tachycardias, requiring new interventional therapy.
authors.affiliation: University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Leipzig, Germany. kobza@freesurf.ch
authors.forename: Richard
authors.initials: R
authors.lastname: Kobza
authors.forename: Hans
authors.initials: H
authors.lastname: Kottkamp
authors.forename: Anja
authors.initials: A
authors.lastname: Dorszewski
authors.forename: Hildegard
authors.initials: H
authors.lastname: Tanner
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.forename: Petra
authors.initials: P
authors.lastname: Schirdewahn
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Gerds-Li
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D001282:Atrial Flutter / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors