Clinical characteristics and ablation outcomes of recurrent atrial
tachyarrhythmia after Maze operation -A multicenter study in Fukuoka
Abstract
Backgrounds: Catheter ablation of recurrent atrial
tachyarrhythmia after Maze operation is challenging due to complex
arrhythmia circuits. The aim of this study was to clarify the
characteristics and ablation outcomes of atrial tachyarrhythmias after
Maze operation. Methods and Results: Twenty-eight cases who
underwent catheter ablation of post-Maze procedure atrial
tachyarrhythmia (42 sessions; 1.5 per patient) in our 5 teaching
affiliate hospitals were retrospectively analyzed. Cox-Ⅳ Maze procedure
and left atrial Maze were performed in 19 cases and 5 cases,
respectively. Mean interval between the surgery and index ablation was
62.4 months. In total, 46 atrial tachyarrhythmias were studied.
Reentrant atrial tachycardia (AT) was the most common form (n=36),
whereas 4 atrial fibrillation (AF) and 2 focal AT were also observed.
Identified tachyarrhythmia circuits were as follows; 16 peri-mitral, 9
left atrial localized reentry (4 septal, 3 posterior, 1 left atrial
appendage, 1 anterior), 6 right atrial lateral incision-related, 5
cavo-tricuspid isthmus dependent, 3 roof dependent, 2 right atrial
localized reentry (1 coronary sinus, 1 cavo-tricuspid isthmus), 1
bi-atrial reentry, 1 pulmonary vein-left atrial reentrant tachycardia, 2
focal AT (1 para-hisian, 1 coronary sinus), and 1 atrio-ventricular
nodal reentry. Termination of targeted tachyarrhythmia was achieved in
34 sessions (81%). AT/AF recurrence free rate at 12, 24, 36 months of
follow-up were 91.8%, 81.6%, and 65.3%, respectively. Seven cases
underwent multiple sessions (two 2 nd sessions, three
3 rd sessions, and two 4 th
sessions). In these cases, de-novo atrial tachyarrhythmias were detected
in the repeat procedures. Conclusions: Most of the atrial
tachyarrhythmias after Maze operation were incision/gap-related
reentrant ATs, among which peri-mitral AT and LA localized reentry were
the most prevalent. Although these challenging tachyarrhythmias can be
treated with the contemporary mapping techniques, de-novo
tachyarrhythmias can emerge in a remote period.