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.

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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