title: A simple surgical technique to prevent atrial reentrant tachycardia in surgery for congenital heart disease†.
abstract: OBJECTIVE
  To present and test a simple surgical technique that may prevent atrial reentrant tachycardia following surgery for congenital heart disease. This arrhythmia is one of the commonest long-term complications of such a surgery. It may occur many years (even decades) after the operation. It is usually explained as a late consequence of right atriotomy, which is an inherent component of many operations for congenital heart disease. Right atriotomy results in a long scar on the right atrial myocardium. This scar, as any scar, is a barrier to electrical conduction, and macro-reentrant circuits may form around it, causing reentrant tachycardia. However, this mechanism may be counterchecked and neutralized by our proposed method, which prevents reentrant circuits around right atriotomy scars.
  
  
  METHODS
  The proposed method is implemented after termination of cardiopulmonary bypass and tying the venous purse-strings. It consists of constructing a full-thickness suture line on the intact right atrial wall from the inferior vena cava (IVC) (a natural conduction barrier) to the atriotomy incision. This suture line is made to cross the venous cannulation sites if these are on the atrial myocardium (rather than being directly on the venae cavae). Thus, the IVC, atriotomy and cannulation sites are connected to each other in series by a full-thickness suture line on the atrial wall. If this suture line becomes a conduction barrier, it would prevent reentrant circuits around right atrial scars. This was tested in 13 adults by electroanatomical mapping. All 13 patients had previously undergone right atriotomy for atrial septal defect closure: 8 of them with the addition of the proposed preventive suture line (treatment group) and 5 without (control group).
  
  
  RESULTS
  In all 13 cases, the atriotomy scar was identified as a barrier to electrical conduction with electrophysiological evidence of fibrosis (scarring). In the 8 patients with the proposed suture line, this had also become a scar and a complete conduction barrier. In the 5 patients without this suture line, there was free electrical conduction between the IVC and atriotomy scar.
  
  
  CONCLUSIONS
  The proposed suture line becomes a scar and conduction barrier. Therefore, it would prevent reentrant circuits around atrial scars and their consequent arrhythmias.
authors.affiliation: The Heart Unit, University Hospitals Virgen del Rocio, Seville, Spain reza@hosseinpour.net.
authors.forename: Amir-Reza
authors.initials: AR
authors.lastname: Hosseinpour
authors.affiliation: The Heart Unit, University Hospitals Virgen del Rocio, Seville, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Adsuar-Gómez
authors.affiliation: The Heart Unit, University Hospitals Virgen del Rocio, Seville, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: González-Calle
authors.affiliation: The Heart Unit, University Hospitals Virgen del Rocio, Seville, Spain.
authors.forename: Alonso
authors.initials: A
authors.lastname: Pedrote
authors.affiliation: The Heart Unit, University Hospitals Virgen del Rocio, Seville, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arana-Rueda
authors.affiliation: The Heart Unit, University Hospitals Virgen del Rocio, Seville, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: García-Riesco
authors.affiliation: The Heart Unit, University Hospitals Virgen del Rocio, Seville, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Arce-León
authors.affiliation: The Heart Unit, University Hospitals Virgen del Rocio, Seville, Spain.
authors.forename: Adriano
authors.initials: A
authors.lastname: Jiménez-Velasco
authors.affiliation: The Heart Unit, University Hospitals Virgen del Rocio, Seville, Spain.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Borrego-Domínguez
authors.affiliation: The Heart Unit, University Hospitals Virgen del Rocio, Seville, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ordóñez-Fernández
mesh_terms: D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D013615:Tachycardia, Sinoatrial Nodal Reentry / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
keywords: Arrhythmias; Atrial flutter; Congenital heart disease; Prophylactic surgery; Reentrant atrial tachycardia; Surgical technique