title: Ablation of left atrial flutter in a patient surgically treated for atrial fibrillation. Does it indicate a possible hybrid approach?
abstract: Surgical treatment of atrial fibrillation (AF) has a high success rate and nowadays simpler and faster procedures have been proposed. The following is a description of the case of a patient who, after a modified Maze procedure, developed an atypical left atrial flutter and underwent a successful radiofrequency ablation procedure. A 71-year-old male underwent surgical biological valve replacement and a concomitant modified Maze procedure. After surgery the patient developed a persistent atrial arrhythmia with severe symptoms and refractory to any drug. For this reason, an electrophysiological study was planned. We performed a three-dimensional atrial mapping using the real-time position management system (Boston Scientific). Right atrial mapping indicated an early activation area on the septum. After transseptal puncture, left atrial mapping showed a reentry circuit around the mitral annulus with positive entrainment. A linear lesion was made between the mitral annulus and the superior right pulmonary vein and sinus rhythm was restored. After 7 months of follow-up the patient is asymptomatic and still in stable sinus rhythm. In conclusion, the follow-up of surgical AF may be improved by close collaboration between the surgeon and electrophysiologist. The available data suggest that a combined surgical and percutaneous approach could be the strategy of choice.
authors.affiliation: Cardiology Unit, Maggiore Hospital, Bologna, Italy. Gaetano.Barbato@ausl.bologna.it
authors.forename: Gaetano
authors.initials: G
authors.lastname: Barbato
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marinelli
authors.forename: Valeria
authors.initials: V
authors.lastname: Carinci
authors.forename: Bruno
authors.initials: B
authors.lastname: Chiappini
authors.forename: Francesco
authors.initials: F
authors.lastname: Pergolini
authors.forename: Daniele
authors.initials: D
authors.lastname: Bracchetti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D017115:Catheter Ablation; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*