title: Atrial arrhythmias after surgical maze: findings during catheter ablation.
abstract: OBJECTIVE
  We describe the clinical and electrophysiologic characteristics and management of post "cut and sew" Maze arrhythmias in symptomatic patients.
  
  
  BACKGROUND
  The Cox Maze procedure was developed as a surgical treatment of atrial fibrillation. Until recently, invasive electrophysiologic studies in patients with symptomatic post-operative arrhythmias in this patient population have not been described.
  
  
  METHODS
  The management and clinical course of consecutive patients with post-Maze arrhythmias refractory to antiarrhythmic drugs (AADs) between January 2000 and December 2003 are presented.
  
  
  RESULTS
  Twenty-three patients (15 men) presented 14 +/- 14 months after Maze surgery for treatment of atrial fibrillation (AF). Eight patients underwent "cut and sew" Maze for lone AF with no other surgical indication. Fifteen patients underwent the "cut and sew" Maze procedure in addition to another surgical procedure: mitral valve surgery (11 patients) and coronary artery bypass graft surgery (4 patients). Eight patients (35%) had recurrent AF secondary to recovered conduction around the lines encircling the pulmonary veins. Five patients were documented to have focal atrial tachycardia, which was mapped to the coronary sinus in 3 patients, to the posterolateral right atrium in 1 patient, and to the left atrial (LA) septum in 1 patient. Four patients had right atrium incisional atrial flutter (AFL), and 6 had LA incisional AFL, which was mapped around the mitral valve annulus in 4 patients and around the right pulmonary veins in 2 patients. Twenty-two of the 23 patients were treated successfully with radiofrequency ablation. At 1-year follow-up, 19 patients were arrhythmia-free and taking no AADs.
  
  
  CONCLUSIONS
  After surgical "cut and sew" Maze, approximately one-third of patients experiencing atrial arrhythmias have AF secondary to pulmonary vein-left atrium conduction recovery. Moreover, incisional AFL seems to be a common finding in this group of patients. Catheter-based mapping and ablation of these arrhythmias seems to be feasible and effective.
authors.affiliation: The Center for Atrial Fibrillation, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Oussama M
authors.initials: OM
authors.lastname: Wazni
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Tamer
authors.initials: T
authors.lastname: Fahmy
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: Sergio
authors.initials: S
authors.lastname: Thal
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kanj
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery*; D001282:Atrial Flutter / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D017115:Catheter Ablation; D004594:Electrophysiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged