Prevalence of intra-atrial reentrant tachycardia following mitral valve surgery: Relationship to surgical approach.

Autor: Gandhavadi M; Heart and Vascular Department, The Everett Clinic, Everett, Washington., Cox EJ; Providence Medical Research Center, Providence Health Care, Spokane, Washington.
Jazyk: angličtina
Zdroj: Journal of cardiac surgery [J Card Surg] 2020 Aug; Vol. 35 (8), pp. 1871-1876. Date of Electronic Publication: 2020 Jul 11.
DOI: 10.1111/jocs.14745
Abstrakt: Background and Aim: Mitral valve (MV) surgeries create electrophysiological substrates that give rise to postoperative arrhythmias. MV surgical procedures have been associated with macro- and microreentrant arrhythmogenic circuits, as well as circuits involving the atrial roof. It is not well understood why such arrhythmias develop; therefore, the aim of this study was to describe clinical and procedure characteristics associated with atrial arrhythmias in patients with prior MV surgery.
Methods: This retrospective chart review evaluated patients who had prior MV surgery and ablation procedures for atrial tachycardia between 2014 and 2018 (n = 20). Patients were classified into those exhibiting typical atrial flutter or another atrial tachyarrhythmia.
Results: Within the 20 patient cases reviewed, 30 arrhythmias were documented. Two-thirds of arrhythmias were typical atrial flutter; the percent incidence of arrhythmias originating in the right atrial (RA) roof, around the right atriotomy scar, in the left atrium, and at the crista terminalis was 20%, 3%, 7%, and 7%, respectively. Nearly every case of RA roof flutter (n = 5/6) and most arrhythmias (n = 20/30) occurred in patients who had a transseptal approach during MV surgery. Voltage maps did not show clear differences in scarring between groups.
Conclusion: Results from this study suggest that an arrhythmogenic substrate for RA roof tachycardias is generated by transseptal approaches for MV surgery. This substrate is not clearly related to a surgical scar. These data suggest that other approaches should be considered for MV surgeries. Additionally, more research is needed to determine the mechanism for this nonscar-related arrhythmia substrate.
(© 2020 Wiley Periodicals LLC.)
Databáze: MEDLINE
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