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Catheter ablation of atrial tachycardia after open heart surgery: outcomes and the mechanism of recurrence with longterm follow-up

Authors: Serguladze S.Yu., Kvasha B.I., Pronicheva I.V., Lyubkina E.V., Sopov O.V., Suladze V.G.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2022-16-1-61-76

For citation: Serguladze S.Yu., Kvasha B.I., Pronicheva I.V., Lyubkina E.V., Sopov O.V., Suladze V.G. Catheter ablation of atrial tachycardia after open heart surgery: outcomes and the mechanism of recurrence with long-term followup. Creative Cardiology. 2022; 16 (1): 61–76 (in Russ.). DOI: 10.24022/1997-3187-2022-16-1-61-76

Received / Accepted:  03.08.2021 / 25.02.2022

Keywords: congenital heart disease acquired heart disease atrial tachycardia atrial flutter navigational mapping system radiofrequency ablation

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Abstract

Objective. To study the early and long-term outcomes of radiofrequency ablation (RFA) of atrial tachycardia (AT) complicating open heart surgery.

Material and methods. The study included 89 cardiac surgery patients (51 men; mean age 46.5 ± 17.2 years) with AT mean duration of 28.9 ± 13.7 months. Formed 4 groups: 1st (n = 15) – cannulation without atriotomy, 2nd (n = 17) – atriotomy of the right atrium, 3rd (n = 34) – interventions on the atrial septum (AS), 4th (n = 23) – atriotomy of the left atrium (LA). All patients underwent RFA of AT using intracardiac electroanatomical mapping (EAM). During the mean follow-up period of 49.2 ± 21.6 months, 32 repeat RFAs were performed. Evaluated: characteristics of arrhythmias, causes of recurrence, complications.

Results. Primary EAM verified 107 ATs in 89 patients: 49 (45%) cavotricuspid isthmus-dependent re-entry, 28 (26%) right atrial non-isthmus-dependent macrore-entry, 15 (14%) perimitral re-entry, 7 (6%) re-entry and 8 (7%) focal ATs dependent on the arch of the LA (> 1 tachycardia had 18 (22%) patients). The frequency of isthmus-dependent re-entry did not differ between groups (p > 0.05). In groups 2, 3, and 4, independent re-entry prevailed (p = 0.041; p = 0.026 and p = 0.037), in 4 group – perimitral re-entry (p<0.001). Primary RFA failed in 4 (5%) patients. AT recurrence was noted in 27% of patients, the highest prevalence in group 3 (p = 0.021). Repeated EAM revealed 5 cases of recurrence of typical atrial, new ectopic lesions (22%), perimitral re-entry (13%), right atrial re-entry (16%) and non-atriotomy scar-related new re-entry contours (34%). At the end of follow-up 87% of patients were in stable sinus rhythm, 13% patients required antiarrhythmic therapy.

Conclusion. Long-term follow-up after RFA showed that recurrence AT due to ruptures in previous ablation lines, the presence of a postoperative scar, or the appearance of a new scar not associated with the incision. Although several procedures may be required, radiofrequency ablation using a 3D electro-anatomical mapping system remains an effective and safe treatment for this patient population.

References

  1. Markowitz S.M., Thomas G., Liu C.F., Cheung J.W., Ip J.E., Lerman B.B. Atrial tachycardias and atypical atrial flutters: mechanisms and approaches to ablation. Arrhythm. Electrophysiol. Rev. 2019; 8 (2): 131–7. DOI: 10.15420/aer.2019.17.2
  2. Miura K., Kimura M., Anzai A., Arai T., Kawakami T., Yuasa S. et al. Predictors of new-onset atrial tachyarrhythmias after transcatheter atrial septal defect closure in adults. Heart Lung Circ. 2021: S1443-9506(21)00106-2. DOI: 10.1016/j.hlc.2021.02.018
  3. Wadia S.K., Lluri G., Aboulhosn J.A., Laks H., Biniwale R.M., Van Arsdell G.S. et al. Postoperative and short-term atrial tachyarrhythmia burdens after transcatheter vs surgical pulmonary valve replacement among congenital heart disease patients. Congenit. Heart Dis. 2019; 14 (5): 838–45. DOI: 10.1111/chd.12818
  4. Brouwer C., Hazekamp M.G., Zeppenfeld K. Anatomical substrates and ablation of reentrant atrial and ventricular tachycardias in repaired congenital heart disease. Arrhythm. Electrophysiol. Rev. 2016; 5 (2): 150–60. DOI: 10.15420/AER. 2016.19.2
  5. Jani C., Arora S., Zuzek Z., Jaswaney R., Thakkar S., Patel H.P. et al. Impact of catheter ablation in patients with atrial flutter and concurrent heart failure. Heart Rhythm O2. 2020; 2 (1): 53–63. DOI: 10.1016/j.hroo.2020.11.005
  6. Roca-Luque I., Rivas Gándara N., Dos Subirá L., Francisco Pascual J., Pérez-Rodon J., Pijuan Domenech A. et al. Intra-atrial re-entrant tachycardia in patients with congenital heart disease: factors associated with disease severity. Europace. 2018; 20 (8): 1343–51. DOI: 10.1093/europace/eux180
  7. Roca-Luque I., Rivas-Gándara N., Dos-Subirá L., Francisco-Pascual J., Pijuan-Domenech A., Pérez-Rodon J. et al. Predictors of acute failure ablation of intra-atrial re-entrant tachycardia in patients with congenital heart disease: cardiac disease., atypical flutter., and previous atrial fibrillation. J. Am. Heart Assoc. 2018; 7 (7): e008063. DOI: 10.1161/JAHA.117.008063
  8. Lukac P., Pedersen A.K., Mortensen P.T., Jensen H.K., Hjortdal V., Hansen P.S. Ablation of atrial tachycardia after surgery for congenital and acquired heart disease using an electroanatomic mapping system: Which circuits to expect in which substrate? Heart Rhythm. 2005; 2 (1): 64–72. DOI: 10.1016/j.hrthm.2004.10.034
  9. De Groot N.M., Zeppenfeld K., Wijffels M.C., Chan W.K., Blom N.A., Van der Wall E.E. et al. Ablation of focal atrial arrhythmia in patients with congenital heart defects after surgery: role of circumscribed areas with heterogeneous conduction. Heart Rhythm. 2006; 3 (5): 526–35. DOI: 10.1016/j.hrthm.2006.01.011
  10. Houck C.A., Chandler S.F., Bogers A.J.J.C., Triedman J.K., Walsh E.P., de Groot N.M.S. et al. Arrhythmia mechanisms and outcomes of ablation in pediatric patients with congenital heart disease. Circ. Arrhythm. Electrophysiol. 2019; 12 (11): e007663. DOI: 10.1161/CIRCEP.119.007663
  11. Kvasha B.I., Serguladze S.Yu., Pronicheva I.I., Lyubkina E.V., Sopov O.V., Maconashvili G.R., Mustapaeva Z.I. Possibilities of surface electrocardiographic mapping in catheter ablation of atrial arrhythmias after surgical treatment of mitral heart disease. Annaly Aritmologii (Annals of Arrhythmology). 2020; 17 (2): 97–110 (in Russ.). DOI: 10.15275/annaritmol.2020.2.3
  12. Anguera I., Dallaglio P., Macías R., JiménezCandil J., Peinado R., García-Seara J. et al. Longterm outcome after ablation of right atrial tachyarrhythmias after the surgical repair of congenital and acquired heart disease. Am. J. Cardiol. 2015; 115 (12): 1705–13. DOI: 10.1016/j.amjcard. 2015.03.017
  13. Chen H., Yang B., Ju W., Zhang F., Gu K., Li M. et al. Long-term outcome following ablation of atrial tachycardias occurring after mitral valve replacement in patients with rheumatic heart disease. Pacing Clin. Electrophysiol. 2013; 36 (7): 795–802. DOI: 10.1111/pace.12153
  14. De Groot N.M., Lukac P., Schalij M.J., Makowski K., Szili-Torok T., Jordaens L. et al. Long-term outcome of ablative therapy of post-operative atrial tachyarrhythmias in patients with tetralogy of Fallot: a European multi-centre study. Europace. 2012; 14 (4): 522–7. DOI: 10.1093/europace/eur313
  15. De Groot N.M., Atary J.Z., Blom N.A., Schalij M.J. Long-term outcome after ablative therapy of postoperative atrial tachyarrhythmia in patients with congenital heart disease and characteristics of atrial tachyarrhythmia recurrences. Circ. Arrhythm. Electrophysiol. 2010; 3 (2): 148–54. DOI: 10.1161/CIRCEP.109.909838
  16. Wang H., Wang C., Chen J., Zhao L., Pan X. Long-term outcome of catheter ablation for atrial tachyarrhythmias in patients with atrial septal defect. J. Interv. Card. Electrophysiol. 2019; 54 (3): 217–24. DOI: 10.1007/s10840-018-0505-1
  17. Aktas M.K., Khan M.N., Di Biase L., Elayi C., Martin D., Saliba W., Cummings J., Schweikert R., Natale A. Higher rate of recurrent atrial flutter and atrial fibrillation following atrial flutter ablation after cardiac surgery. J. Cardiovasc. Electrophysiol. 2010; 21 (7): 760–5. DOI: 10.1111/j.1540-8167.2009.01709.x
  18. Anné W., van Rensburg H., Adams J., Ector H., Van de Werf F., Heidbüchel H. Ablation of postsurgical intra-atrial reentrant tachycardia. Predilection target sites and mapping approach. Eur. Heart J. 2002; 23 (20): 1609–16. DOI: 10.1053/euhj.2002.3168
  19. Hosseinpour A.R., Adsuar-Gómez A., GonzálezCalle A., Pedrote A., Arana-Rueda E., GarcíaRiesco L. et al. A simple surgical technique to prevent atrial reentrant tachycardia in surgery for congenital heart disease. Interact. Cardiovasc. Thorac. Surg. 2016; 22 (1): 47–52. DOI: 10.1093/icvts/ivv268
  20. Pap R., Kohári M., Makai A., Bencsik G., Traykov V.B., Gallardo R. et al. Surgical technique and the mechanism of atrial tachycardia late after open heart surgery. J. Interv. Card. Electrophysiol. 2012; 35 (2): 127–35. DOI: 10.1007/s10840-012- 9705-2
  21. Lukac P., Hjortdal V., Pedersen A.K., Jensen H.K., Mortensen P.T., Hansen P.S. The superior transseptal surgical approach to mitral valve creates slow conduction. Pacing Clin. Electrophysiol. 2006; 29 (7): 719–26. DOI: 10.1111/j.1540-8159.2006. 00425.x
  22. John B., Stiles M.K., Kuklik P., Chandy S.T., Young G.D., Mackenzie L. et al. Electrical remodelling of the left and right atria due to rheumatic mitral stenosis. Eur. Heart J. 2008; 29 (18): 2234–43. DOI: 10.1093/eurheartj/ehn329
  23. Sergeev A.V., Bockeria O.L., Melikulov A.H., Klimchuk I.Yа., Turdubaev A.K., Bockeria L.A. Electrophysiological features of left atrial arrhythmias after surgical ablation of atrial fibrillation. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2017; 18 (5): 472–8 (in Russ.). DOI: 10.24022/1810-0694-2017-18-5-472-478
  24. Yap S.C., Harris L., Silversides C.K., Downar E., Chauhan V.S. Outcome of intra-atrial re-entrant tachycardia catheter ablation in adults with congenital heart disease: negative impact of age and complex atrial surgery. J. Am. Coll. Cardiol. 2010; 56 (19): 1589–96. DOI: 10.1016/j.jacc. 2010.04.061
  25. Pérez F.J., Schubert C.M., Parvez B., Pathak V., Ellenbogen K.A., Wood M.A. Long-term outcomes after catheter ablation of cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis. Circ. Arrhythm. Electrophysiol. 2009; 2 (4): 393–401. DOI: 10.1161/CIRCEP.109.871665
  26. Verma A., Marrouche N.F., Seshadri N., Schweikert R.A., Bhargava M., Burkhardt J.D. et al. Importance of ablating all potential right atrial flutter circuits in postcardiac surgery patients. J. Am. Coll. Cardiol. 2004; 44 (2): 409–14. DOI: 10.1016/j.jacc.2004.04.045
  27. Filatov A.G., Golukhova E.Z., Ryabinina M.N., Kovalev A.S. Successful radiofrequency ablation of atypical left atrial flutter via three-dimensional nonfluoroscopic navigational system SJM EnSite Velocity: a case report. Creative Cardiology. 2014; 8 (2): 60–70 (in Russ.).
  28. Wieczorek M., Hoeltgen R. Right atrial tachycardias related to regions of low-voltage myocardium in patients without prior cardiac surgery: catheter ablation and follow-up results. Europace. 2013; 15 (11): 1642–50. DOI: 10.1093/europace/eut056
  29. Bockeria L.A., Filatov A.G., Kovalev A.S. Electrophysiological markers of early manifestation of atrial fibrillation in patients with atrial tachycardia. Annaly Aritmologii (Annals of Arrhythmology). 2017; 14 (1): 40–4 (in Russ.). DOI: 10.15275/annaritmol.2017.1.5
  30. Roberts-Thomson K.C., John B., Worthley S.G., Brooks A.G., Stiles M.K., Lau D.H. et al. Left atrial remodeling in patients with atrial septal defects. Heart Rhythm. 2009; 6 (7): 1000–6. DOI: 10.1016/j.hrthm.2009.03.050
  31. Contractor T., Mandapati R. Arrhythmias in patients with atrial defects. Card. Electrophysiol. Clin. 2017; 9 (2): 235–44. DOI: 10.1016/j.ccep. 2017.02.006
  32. Jin X., Hummel Y.M., Tay W.T., Nauta J.F., Bamadhaj NSS., van Melle J.P. et al. Short- and long-term haemodynamic consequences of transcatheter closure of atrial septal defect and patent foramen ovale. Neth. Heart J. 2021; 29 (7–8): 402–8. DOI: 10.1007/s12471-021-01543-0

About Authors

  • Sergey Yu. Serguladze, Dr. Med. Sci., Professor, Head of Department, Cardiovascular Surgeon; ORCID
  • Boris I. Kvasha, Cand. Med. Sci., Сardiovascular Surgeon; ORCID
  • Irina V. Pronicheva, Cand. Med. Sci., Senior Researcher, Cardiologist; ORCID
  • Elena V. Lyubkina, Cand. Med. Sci., Сardiovascular Surgeon; ORCID
  • Oleg V. Sopov, Cand. Med. Sci., Сardiovascular Surgeon; ORCID
  • Vladimir G. Suladze, Сardiovascular Surgeon; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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