Stable secondary arrhythmias late after intraoperative radiofrequency ablation of atrial fibrillation: incidence, mechanism, and treatment.
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.
Kobza
Richard
R
University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Leipzig, Germany. kobza@freesurf.ch
Kottkamp
Hans
H
Dorszewski
Anja
A
Tanner
Hildegard
H
Piorkowski
Christopher
C
Schirdewahn
Petra
P
Gerds-Li
Jin-Hong
JH
Hindricks
Gerhard
G
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