title: Catheter ablation of symptomatic postoperative atrial arrhythmias after epicardial surgical disconnection of the pulmonary veins and left atrial appendage ligation in patients with atrial fibrillation.
abstract: OBJECTIVE
  Minimally invasive thoracoscopic epicardial pulmonary vein isolation (MIPI) has an important role in the surgical treatment of atrial fibrillation (AF). However, the management of recurrent atrial arrhythmias after MIPI and long-term success rate of catheter ablation have not been well studied.
  
  
  METHODS
  Electrophysiological study was performed in 23 patients, 378 ± 282 days after MIPI surgery, because of recurrent symptomatic atrial arrhythmias.
  
  
  RESULTS
  A total of 20 patients presented with paroxysmal and persistent AF, 2 patients had a combination of AF and atrial tachycardia (AT) and 1 patient had a combination of AF and atrial flutter. All patients showed pulmonary vein (PV) reconnection. ATs were micro-re-entry PV-related ATs and atrial flutter was cavotricuspid isthmus dependent. Eighteen of 23 patients (78.3%) were free of atrial arrhythmias after one catheter ablation procedure at a mean follow-up of 50 ± 16 months. Three patients underwent a second ablation procedure for recurrent AF and macro-re-entry left atrial flutter. Eventually 20 of 23 patients (87%) remained free of atrial arrhythmias after a mean of 1.1 ± 0.3 ablation procedures.
  
  
  CONCLUSIONS
  Catheter ablation of recurrent atrial arrhythmias following MIPI for paroxysmal and persistent AF is a feasible and effective treatment with a good long-term success rate. Reconnection of PVs accounts for most recurrences.
authors.affiliation: Isala Hospital, Zwolle, The Netherlands.
authors.forename: Rypko J
authors.initials: RJ
authors.lastname: Beukema
authors.affiliation: Isala Hospital, Zwolle, The Netherlands.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Adiyaman
authors.affiliation: Isala Hospital, Zwolle, The Netherlands.
authors.forename: Jaap Jan J
authors.initials: JJ
authors.lastname: Smit
authors.affiliation: Isala Hospital, Zwolle, The Netherlands.
authors.forename: Peter Paul H M
authors.initials: PP
authors.lastname: Delnoy
authors.affiliation: Isala Hospital, Zwolle, The Netherlands.
authors.forename: Anand R
authors.initials: AR
authors.lastname: Ramdat Misier
authors.affiliation: Isala Hospital, Zwolle, The Netherlands v.r.c.derks@isala.nl.
authors.forename: Arif
authors.initials: A
authors.lastname: Elvan
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000601:surgery*; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery; D001282:Atrial Flutter / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D013610:Tachycardia / Q000601:surgery; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Minimally invasive surgical ablation; Pulmonary vein isolation