title: Surgical technique and the mechanism of atrial tachycardia late after open heart surgery.
abstract: BACKGROUND
  Diverse atrial tachycardias (ATs) can develop after open heart surgery. The aim of our study was to examine the determinants of the mechanism of postoperative AT.
  
  
  RESULTS
  One hundred patients with AT occurring at least 3 months after open heart surgery were studied. Patients were grouped according to the atrial incision applied at the time of surgery. During 127 electrophysiology procedures, 151 ATs were studied. Eighty-eight patients had cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL), 49 patients had at least one non-CTI-dependent AFL and 11 patients had focal AT. While CTI-dependent AFL was equally prevalent across groups, the finding of a non-CTI-dependent AFL was progressively more common as more extensive atriotomy was applied (p < 0.001). Among patients who had right atrial (RA) operations, RA incisional tachycardia was the most common non-CTI-dependent circuit, while the finding of perimitral or left atrial (LA) roof-dependent AFL was associated with LA atriotomy (p = 0.002 and p = 0.041, respectively). After adjustment for possible confounders, surgical group remained independent predictor of non-CTI-dependent AFLs (p < 0.001). No predictor was identified for focal AT, which originated from typical predilection sites and in 36% from the vicinity of surgical scar. Radiofrequency ablation was highly effective for all ATs, but the recurrence rate of AFL and atrial fibrillation was high at 22% and 27%, respectively, during 19 ± 15 months of follow-up.
  
  
  CONCLUSIONS
  While CTI-dependent AFL is the most common AT late after open heart surgery, atypical AFL becomes progressively more common with more extensive atriotomy. Right atrial incisional tachycardia is the dominant non-CTI-dependent AFL after opening of the RA, while a perimitral or roof-dependent LA circuit can be expected after LA operations.
authors: 2nd Department of Medicine and Cardiology Centre, University of Szeged, Korányi fasor 6, 6720, Szeged, Hungary pap.paprobert@gmail.com
authors: Róbert
authors: R
authors: Pap
authors: Mária
authors: M
authors: Kohári
authors: Attila
authors: A
authors: Makai
authors: Gábor
authors: G
authors: Bencsik
authors: Vassil Borislavov
authors: VB
authors: Traykov
authors: Rodrigo
authors: R
authors: Gallardo
authors: Gergely
authors: G
authors: Klausz
authors: Kis
authors: K
authors: Zsuzsanna
authors: Tamás
authors: T
authors: Forster
authors: László
authors: L
authors: Sághy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001282:Atrial Flutter / Q000453:epidemiology* / Q000503:physiopathology* / Q000601:surgery; D006348:Cardiac Surgical Procedures; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology* / Q000601:surgery; D015995:Prevalence; D012307:Risk Factors; D013617:Tachycardia, Supraventricular / Q000453:epidemiology* / Q000503:physiopathology* / Q000601:surgery