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ORIGINAL ARTICLE  INTERVENTIONAL THERAPY OF CARDIAC ARRHYTHMIAS 

Minerva Cardiology and Angiology 2021 February;69(1):94-101

DOI: 10.23736/S2724-5683.20.05405-5

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Ablation of atrial tachycardia in the setting of prior mitral valve surgery

Jacopo MARAZZATO 1, Giangiuseppe CAPPABIANCA 1, Fabio ANGELI 1, 2, Matteo CRIPPA 1, Michele GOLINO 1, Sandro FERRARESE 1, Cesare BEGHI 1, Roberto DE PONTI 1

1 Department of Medicine and Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi University Hospital, Varese, Italy 2 Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy



BACKGROUND: Data regarding catheter ablation of post-surgical atrial tachycardia occurring after mitral valve surgery are scarce. Through a search of the literature, this study aimed to assess the feasibility of catheter ablation and the characteristics of atrial arrhythmias ablated in these patients.
METHODS: Studies assessing the main procedure parameters and the electrophysiologic findings of the investigated atrial tachycardia were selected. The electrophysiologic mechanism (focal vs. re-entrant arrhythmias), site of arrhythmia origin (left atrium vs. right atrium) and their anatomic correlation with specific surgical access and/or prior Cox-Maze IV procedure were all addressed.
RESULTS: Eleven studies including 206 patients undergoing catheter ablation of 297 post-surgical arrhythmia morphologies occurring after mitral valve surgery were considered. Major complications were observed in 2 patients only (0.9%). Restoration of sinus rhythm was achieved in 96% of patients. Macro-reentrant arrhythmia was mostly observed (90.4%) with a non-negligible proportion of focal arrhythmia (9.6%). Left-sided arrhythmia was common (54.4%,) but cavotricuspid isthmus-dependent arrhythmia was frequently reported (33%). Although specific atriotomies showed trends towards peculiar locations of the investigated arrhythmia, Cox-Maze IV procedure was the only independent predictor for left-sided arrhythmia (OR=17.3; 95% CI 7.2-41.2; P<0.0001).
CONCLUSIONS: Catheter ablation of post-surgical arrhythmia occurring after mitral valve surgery is feasible, and, in this setting, the vast majority of the arrhythmia morphologies are based on macro-reentry and in about one third of cases show cavotricuspid isthmus-dependent arrhythmia. Prior Cox-Maze-IV associated with mitral valve surgery is an independent predictor of left-sided arrhythmia possibly due to non-transmural surgical lesions.


KEY WORDS: Catheter ablation; Atrial flutter; Mitral valve annuloplasty; Heart valve prosthesis; Maze procedure

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