Document Detail

Left Septal Atrial Tachycardia after Open-Heart Surgery: Relevance to Surgical Approach, Anatomical and Electrophysiological Characteristics Associated with Catheter Ablation, and Procedural Outcomes.
MedLine Citation:
PMID:  25416037     Owner:  NLM     Status:  Publisher    
BACKGROUND: -Septal atrial tachycardia (AT) can occur in patients without structural heart disease and in patients with prior catheter ablation of atrial fibrillation. We aimed to assess septal AT that occurs after open-heart surgery.
METHODS AND RESULTS: -This study comprised 20 consecutive patients undergoing catheter ablation of macroreentrant AT after open-heart surgery. Relevance to surgical approach, mechanisms, anatomical and electrophysiological characteristics, and outcomes were assessed. Septal AT was identified in 7 patients who had all undergone mitral valve surgery. All septal ATs were localized in the left atrial septum, whereas 10 of 13 non-septal ATs originated from the right atrium. Patients with left septal AT had a thicker fossa ovalis (median: 4.0, 25(th)-75(th) percentile: 3.6-4.2 vs 2.3, 1.6-2.6 mm, p=0.006) and broader area of low voltage (<0.3 mV) in the septum than patients with non-septal AT (82, 76-89 vs 31, 28-36%, p=0.02). Repeated gradual prolongations of the tachycardia cycle length without change of the septal circuit was observed in all patients with septal AT (70, 63-100 vs 15, 10-40 ms, p=0.0008). Although ablation terminated all ATs, recurrence of targeted ATs was more frequent in patients with left septal AT during 30-month follow-up (71 vs 0%, p=0.001).
CONCLUSIONS: -Left septal AT after open-heart surgery was characterized by a thicker septum, more scar burden in the septum, and repeated prolongations of the tachycardia cycle length during ablation. Such an arrhythmogenic substrate may interfere with transmural lesion formation by ablation and may account for higher likelihood of recurrence of left septal AT.
Toru Adachi; Kentaro Yoshida; Noriyuki Takeyasu; Keita Masuda; Yukio Sekiguchi; Akira Sato; Hiroshi Tada; Akihiko Nogami; Kazutaka Aonuma
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-21
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-22     Completed Date:  -     Revised Date:  2014-11-25    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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