Impact assessment of various factors on the prognosis of catheter treatment of incision atrial tachycardias

Authors: Kvasha B.I., Serguladze S.Yu., Pronicheva I.V., Biganov R.M., Baturkin L.Yu., Lyubkina E.V.

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

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Type:  Original articles


For citation: Kvasha B.I., Serguladze S.Yu., Pronicheva I.V., Biganov R.M., Baturkin L.Yu., Lyubkina E.V. Impact assessment of various factors on the prognosis of catheter treatment of incision atrial tachycardias. Creative Cardiology. 2023; 17 (1): 124–39 (in Russ.). DOI: 10.24022/1997-3187-2023-17-1-124-139

Received / Accepted:  28.09.2022 / 10.01.2023

Keywords: atrial arrhythmia atrial tachycardia atrial flutter catheter ablation risk factors prognostic mathematical model

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Objective. To assess the frequency of recurrence of atrial tachycardias (AT) after radiofrequency ablation (RFA) in patients undergoing open heart surgery and the contribution of various risk factors to the prognosis of the effectiveness of catheter treatment.

Material and methods. The retrospective study included 135 patients with a median (ME) of age 42 [30.76; 47.25] years, operated on for congenital (n=78, 58%) and acquired (n=57, 42%) heart disease. All ATs occurred in the late period after cardiac surgery (ME 110.4 [64.7; 187.2] months). All patients underwent RFA: 112 (83%) had an effect, 23 (17%) after RFA required cardioversion. All were discharged on sinus rhythm, ME of observation was 48 [44.75; 51.0] months. The recurrence rate was 47.4% (n=64). The factors influencing the development of relapse were studied. Mann-Whitney, Fisher, χ2 methods were used for data processing and analysis, and multivariate logistic regression was used to develop a predictive model.

Results. According to the preliminary analysis, obesity (p=0.031), hypertension (p=0.028), atrial septal intervention (ASI) (p=0.001), isthmus-independent re-entry (p=0.001), multiple independent macrore-entry circles (p=0.002) and greater left atrial volume (LA) (p=0.017), LA diameter (p=0.019) and right atrial diameter (RA) (p=0.016) were significantly associated with recurrence. Low adherence to antiarrhythmic therapy influenced the likelihood of recurrence in patients after cardioversion (p=0.049). ROC-analysis yielded statistically significant threshold values for LA volume ≥ 135 ml (Se 79.5%, Sp 81.1%), LA diameter ≥ 52 mm (Se 73.8%, Sp 83.4 %) and PP diameter ≥ 55 mm (Se 84.1%, Sp 75.1%). Using the results obtained, a multivariate analysis was performed. The most significant predictors were the isthmus-independent form of arrhythmia, multiple cycles of arrhythmia and the type of surgical approach, their weight coefficients were 2.02; 1.94 and 1.71, respectively. The value of the logistic function P for predicting relapse was 0.731 with Se – 86% and Sp – 91%.

Conclusion. The highest probability of recurrence of incisional PT in patients after RFA was noted if they had simultaneous surgery for the atrial septum, isthmus-independent re-entry, multiple independent cycles of tachycardia and atrial dilatation. The high risk of arrhythmia recurrence after RFA should be taken into account, risk factors in treatment planning should be identified and taken into account, with particular attention to patient adherence to prophylactic antiarrhythmic therapy.


  1. Bockeria L.A., Filatov A.G., Tarashvili E.G. The case of successful radiofrequency ablation of ectopic left atrial tachycardias foci and ablation of the left posterolateral accessory atrioventricular pathways. Annaly Aritmologii (Annals of Arrhythmology). 2017; 14 (3): 165–70 (in Russ.). DOI: 10.15275/annaritmol.2017.3.7
  2. 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
  3. Brembilla-Perrot B., Ferreira J.P., Manenti V., Sellal J.M., Olivier A., Villemin T. et al. Predictors and prognostic significance of tachycardiomyopathy: insights from a cohort of 1269 patients undergoing atrial flutter ablation. Eur. J. Heart Fail. 2016; 18 (4): 394–401. DOI: 10.1002/ ejhf.482
  4. Kondo M., Fukuda K., Wakayama Y., Nakano M., Hasebe Y., Satake H. et al. Different characteristics of postoperative atrial tachyarrhythmias between congenital and non-congenital heart disease. J. Interv. Card. Electrophysiol. 2020; 58 (1): 1–8. DOI: 10.1007/s10840-019-00575-2
  5. Nakagawa H., Shah N., Matsudaira K., Overholt E., Chandrasekaran K., Beckman K.J. et al. Characterization of reentrant circuit in macroreentrant right atrial tachycardia after surgical repair of congenital heart disease: isolated channels between scars allow “focal” ablation. Circulation. 2001; 103 (5): 699–709. DOI: 10.1161/01.cir.103.5.699
  6. Ueda A., Adachi I., McCarthy K.P., Li W., Ho S.Y., Uemura H. Substrates of atrial arrhythmias: histological insights from patients with congenital heart disease. Int. J. Cardiol. 2013; 168 (3): 2481–6. DOI: 10.1016/j.ijcard.2013.03.004
  7. Khairy P., Van Hare G.F., Balaji S., Berul C.I., Cecchin F., Cohen M.I. et al. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease. Can. J. Cardiol. 2014; 30 (10): e1–63. DOI: 10.1016/j.cjca.2014.09.002
  8. Klehs S., Schneider H.E., Backhoff D., Müller M.J., Paul T., Krause U. Repeat radiofrequency catheter ablation of atrial tachycardias in patients with congenital heart disease. J. Cardiovasc. Electrophysiol. 2022; 33 (5): 943–52. DOI: 10.1111/jce.15422
  9. King J.B., Azadani P.N., Suksaranjit P., Bress A.P., Witt D.M., Han F.T. et al. Left atrial fibrosis and risk of cerebrovascular and cardiovascular events in patients with atrial fibrillation. J. Am. Coll. Cardiol. 2017; 70 (11): 1311–21. DOI: 10.1016/j.jacc.2017.07.758
  10. Lau D.H., Nattel S., Kalman J.M., Sanders P. Modifiable risk factors and atrial fibrillation. Circulation. 2017; 136 (6): 583–96. DOI: 10.1161/CIRCULATIONAHA.116.023163
  11. Gulsen K., Demır S., Kup A., Uslu A., Celık M., Kanar B.G. et al. The effect of patient characteristics to the acute procedural success and long term outcome of atrial tachycardia and atrial flutter cases undergoing catheter ablation. Marmara Med. J. 2021; 34 (2): 202–7. DOI: 10.5472/marumj.943128
  12. 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 mechanism of recurrence in long-term follow-up. Creative Cardiology. 2022; 16 (1): 61–76 (in Russ.). DOI: 10.24022/1997- 3187-2022-16-1-61-76
  13. Blomström-Lundqvist C., Scheinman M.M., Aliot E.M., Alpert J.S., Calkins H., Camm A.J. et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines. Circulation. 2003; 108 (15): 1871–909. DOI: 10.1161/01.CIR.0000091380.04100.84
  14. Brugada J., Katritsis D.G., Arbelo E., Arribas F., Bax J.J., Blomström-Lundqvist C. et al. ESC Scientific Document Group. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur. Heart J. 2020; 41 (5): 655–720. DOI: 10.1093/eurheartj/ehz467
  15. Ueda A., Suman-Horduna I., Mantziari L., Gujic M., Marchese P., Ho S.Y. et al. Contemporary outcomes of supraventricular tachycardia ablation in congenital heart disease: a single-center experience in 116 patients. Circ. Arrhythm. Electrophysiol. 2013; 6 (3): 606–13. DOI: 10.1161/CIRCEP. 113.000415
  16. 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
  17. Klehs S., Schneider H.E., Backhoff D., Paul T., Krause U. Radiofrequency catheter ablation of atrial tachycardias in congenital heart disease: results with special reference to complexity of underlying anatomy. Circ. Arrhythm. Electrophysiol. 2017; 10 (12): e005451. DOI: 10.1161/CIRCEP. 117.005451
  18. Arujuna A., de Bono J. Maximizing the effectiveness of ablation for arrhythmias in the congenital heart patients. Curr. Cardiol. Rep. 2016; 18 (7): 69. DOI: 10.1007/s11886-016-0736-7
  19. Mantziari L., Butcher C., Shi R., Kontogeorgis A., Opel A., Chen Z. et al. Characterization of the mechanism and substrate of atrial tachycardia using ultra-high-density mapping in adults with congenital heart disease: impact on clinical outcomes. J. Am. Heart Assoc. 2019; 8 (4): e010535. DOI: 10.1161/JAHA.118.010535
  20. Wang X.H., Kong L.C., Shuang T., Li Z., Pu J. Macro-reentrant atrial tachycardia after tricuspid or mitral valve surgery: is there difference in electrophysiological characteristics and effectiveness of catheter ablation? BMC Cardiovasc. Disord. 2021; 21 (1): 538. DOI: 10.1186/s12872-021-02368-w
  21. Roca-Luque I., Rivas Gándara N., Dos Subirà L., Pascual J.F., Domenech A.P., Pérez-Rodon J. et al. Intra-atrial re-entrant tachycardia in congenital heart disease: types and relation of isthmus to atrial voltage. Europace. 2018; 20 (2): 353–61. DOI: 10.1093/europace/eux250
  22. 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
  23. Zhu X., Chu H., Li J., Wang C., Li W., Wang Z. et al. New discovery of left atrial macroreentry tachycardia: originating from the spontaneous scarring of left atrial anterior wall. J. Interv. Cardiol. 2021; 2021: 2829070. DOI: 10.1155/2021/2829070
  24. Lau D.H., Nattel S., Kalman J.M., Sanders P. Modifiable risk factors and atrial fibrillation. Circulation. 2017; 136 (6): 583–96. DOI: 10.1161/CIRCULATIONAHA.116.023163
  25. 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
  26. Chou C.Y., Chung F.P., Chang H.Y., Lin Y.J., Lo L.W., Hu Y.F. et al. Prediction of recurrent atrial tachyarrhythmia after receiving atrial flutter ablation in patients with prior cardiac surgery for valvular heart disease. Front. Cardiovasc. Med. 2021; 8: 741377. DOI: 10.3389/fcvm.2021.741377
  27. Ma W., Qiu J., Lu F., Shehata M., Wang X., Wu D. et al. Catheter ablation for atrial tachycardias: how to interpret the unclear activation map? Pacing Clin. Electrophysiol. 2021; 44 (2): 274–83. DOI: 10.1111/pace.14083
  28. Huo Y., Gaspar T., Pohl M., Sitzy J., Richter U., Neudeck S. et al. Prevalence and predictors of low voltage zones in the left atrium in patients with atrial fibrillation. Europace. 2018; 20 (6): 956–62. DOI: 10.1093/europace/eux082
  29. Koyak Z., Kroon B., de Groot J.R., Wagenaar L.J., van Dijk A.P., Mulder B.A. et al. Efficacy of antiarrhythmic drugs in adults with congenital heart disease and supraventricular tachycardias. Am. J. Cardiol. 2013; 112 (9): 1461–7. DOI: 10.1016/j.amjcard.2013.07.029
  30. Egbe A.C., Asirvatham S.J., Connolly H.M., Kapa S., Desimone C.V., Vaidya V.R. et al. Outcomes of direct current cardioversion in adults with congenital heart disease. Am. J. Cardiol. 2017; 119 (9): 1468–72. DOI: 10.1016/j.amjcard.2017.01.018

About Authors

  • Boris I. Kvasha, Cand. Med. Sci., Сardiovascular Surgeon; ORCID
  • Sergey Yu. Serguladze, Dr. Med. Sci., Professor, Head of Department, Cardiac Surgeon; ORCID
  • Irina V. Pronicheva, Cand. Med. Sci., Senior Researcher, Cardiologist; ORCID
  • Ruslan M. Biganov, Сardiovascular Surgeon; ORCID
  • Lev Yu. Baturkin, Сardiovascular Surgeon; ORCID
  • Elena V. Lyubkina, Cand. Med. Sci., 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