Document Detail

Surface electrocardiographic patterns and electrophysiologic characteristics of atrial flutter following modified radiofrequency MAZE procedures.
MedLine Citation:
PMID:  17394449     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: The radiofrequency MAZE is becoming a common adjunct to cardiac surgery in patients with atrial fibrillation. While a variety of postoperative arrhythmias have been described following the original Cox-MAZE III procedure, the electrophysiological characteristics and surgical substrate of post-radiofrequency MAZE flutter have not been correlated. We sought to determine the location, ECG patterns, and electrophysiological characteristics of post-radiofrequency MAZE atrial flutter. METHODS: Nine consecutive patients with post-radiofrequency MAZE flutter presented for catheter ablation 9 +/- 10 months after surgery. RESULTS: Only one patient (11%) had an ECG appearance consistent with typical isthmus-dependent right atrial (RA) flutter. However, on electrophysiological study, 3/9 patients (33%) had typical right counter-clockwise flutter entrained from the cavo-tricuspid isthmus, despite description of surgical isthmus ablation. Six patients (67%) had left atrial (LA) circuits. These involved the mitral annulus in 5/6 cases (83%) despite description of surgical mitral isthmus ablation in the majority (60%). LA flutters had a shorter cycle length compared with RA flutters (253 +/- 39 msec and 332 +/- 63 msec respectively, P < 0.05). After a mean of 8 +/- 4 months following ablation, 8/9 patients (89%) were in sinus rhythm. CONCLUSION: Up to one-third of post-radiofrequency MAZE circuits are typical isthmus-dependent RA flutters, despite a highly atypical surface ECG morphology. Therefore, diagnostic electrophysiological studies should commence with entrainment at the cavo-tricuspid isthmus in order to exclude typical flutter, regardless of the surface ECG appearance. Incomplete surgical lesions at the mitral and cavo-tricuspid isthmus likely predispose to the development of post-radiofrequency MAZE flutter.
Joseph G Akar; M Obadah Al-Chekakie; Afroz Hai; Neil Brysiewicz; Michael Porter; Niraj Varma; Peter Santucci; David J Wilber
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  18     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-03-30     Completed Date:  2007-06-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  349-55     Citation Subset:  IM    
Division of Cardiology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois 60153, USA.
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MeSH Terms
Aged, 80 and over
Atrial Flutter / diagnosis*,  etiology*,  surgery
Body Surface Potential Mapping
Catheter Ablation / adverse effects*
Combined Modality Therapy
Electrophysiologic Techniques, Cardiac
Heart Atria / pathology,  physiopathology
Heart Valve Diseases / surgery*
Middle Aged
Treatment Outcome
Comment In:
J Cardiovasc Electrophysiol. 2007 Apr;18(4):356-7   [PMID:  17394450 ]

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