| Surface electrocardiographic patterns and electrophysiologic characteristics of atrial flutter following modified radiofrequency MAZE procedures. | |
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MedLine Citation:
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PMID: 17394449 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: Journal of cardiovascular electrophysiology Volume: 18 ISSN: 1540-8167 ISO Abbreviation: J. Cardiovasc. Electrophysiol. Publication Date: 2007 Apr |
Date Detail:
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Created Date: 2007-03-30 Completed Date: 2007-06-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9010756 Medline TA: J Cardiovasc Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 349-55 Citation Subset: IM |
Affiliation:
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Division of Cardiology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois 60153, USA. jakar@lumc.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Atrial Flutter / diagnosis*, etiology*, surgery Body Surface Potential Mapping Catheter Ablation / adverse effects* Combined Modality Therapy Cryosurgery Electrophysiologic Techniques, Cardiac Female Heart Atria / pathology, physiopathology Heart Valve Diseases / surgery* Humans Male Middle Aged Treatment Outcome |
| Comments/Corrections | |
Comment In:
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J Cardiovasc Electrophysiol. 2007 Apr;18(4):356-7
[PMID:
17394450
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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