title: Atrial arrhythmias following surgical AF ablation: electrophysiological findings, ablation strategies, and clinical outcome.
abstract: BACKGROUND
  Intraoperative atrial fibrillation (AF) ablation during cardiac surgery is a well-established treatment. However, tachycardia mechanisms, ablation strategies, and long-term follow-up of atrial arrhythmias (AA) following intraoperative AF ablation (AFA) have not been previously studied in a large cohort of patients.
  
  
  OBJECTIVE
  Eighty-two patients (48 male, median age of 65 years) with symptomatic recurrence of AA following intraoperative AFA underwent radiofrequency catheter ablation.
  
  
  METHODS
  Regular atrial tachycardias (AT) were mapped using 3-dimensional (3D) color-coded entrainment/activation mapping and eliminated by linear ablation. Pulmonary vein (PV)-isolation (PVI) was achieved in patients with left atrium-PV (LAPV) conduction after AT elimination.
  
  
  RESULTS
  In 85 (83%) out of a total of 103 regular ATs, the entire reentrant circuits were localized perimitrally (n = 27), around PVs (left PV [LPV] or right PV [RPV]; n = 9), around left atrial appendage (LAA; n = 1), on left-sided atrial septum (n = 8), on atrioventricular nodal area (n = 1), on the posterior wall of LA (n = 1), along roof-septum-inferoposterior wall (n = 8), at coronary sinus ostium (n = 2), upper loop in RA (n = 1), and as cavotricuspid isthmus-dependent reentrant ATs (n = 27). Sixty-five (79%) patients received PVI. Noninducibility of any AT was reached at the end of all procedures. During a median follow-up time of 18 months, 69 patients (87%) were free of AA.
  
  
  CONCLUSIONS
  Reentrant AT appears in the majority of patients with recurrence of AA following intraoperative AFA. Detailed 3D color-coded entrainment mapping was successfully obtained in the majority of patients suffering from reentrant AT after intraoperative AFA, facilitated the accurate identification of the entire reentrant circuit and selection of optimal ablation lines.
authors.affiliation: Department of Electrophysiology, Dresden University-Heart Center, Dresden, Germany.
authors.forename: Yan
authors.initials: Y
authors.lastname: Huo
authors.forename: Robert
authors.initials: R
authors.lastname: Schoenbauer
authors.forename: Sergio
authors.initials: S
authors.lastname: Richter
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.forename: Ardawan
authors.initials: A
authors.lastname: Rastan
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doll
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Christopher
authors.initials: C
authors.lastname: Piorkowski
authors.forename: Thomas
authors.initials: T
authors.lastname: Gaspar
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017115:Catheter Ablation / Q000009:adverse effects*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; atrial flutter; atrial tachycardia; catheter ablation; surgical ablation