Comparison of anatomic isthmus block with the modified right atrial maze procedure for late atrial tachycardia in Fontan patients

Background: Atrial tachyarrhythmia is common in adults with tetralogy of Fallot (TOF) due to surgical scarring from repairs and atrial enlargement. The maze procedure refers to surgical ablation within the right atrium to disrupt arrhythmogenic circuits and is sometimes performed concomitantly during reoperation on repaired TOF patients. Our study aims to evaluate the effectiveness of maze in TOF patients. Methods: We performed a retrospective chart review that identified 30 TOF patients who underwent a pulmonary valve replacement (PVR) with maze and 38 TOF patients who underwent a PVR without maze from 1994 to 2011 and had at least 2 years of post-surgical follow-up at the Ahmanson/UCLA Adult Congenital Heart Disease Center. Preoperative and postoperative arrhythmia status and management were compared in maze and non-maze groups. Results: Before the procedure, the most common pre-operative arrhythmias in the maze group were a history of atrial fibrillation (AFib)(n=16), atrial flutter (AFL)(n=10), and other supraventricular tachycardia (SVT)(n=6). Isolated right atrial maze was performed in 26 patients, and combined right and left atrial maze-cox procedure was performed in 4 patients. Of the 16 patients in the maze group with pre-op Afib, 6 had recurrent Afib within the first 2 years of follow-up (62.5% relative reduction, p=0.012). Of the 10 patients with pre-op AFL, only 1 had recurrence (90% relative reduction, p=0.012). Of the 6 patients with pre-op SVT, 4 had recurrence (33.3% relative reduction, p=0.727). There was no significant arrhythmia status change in the non-maze group at 2 years. Comparing patients with and without maze, the average cardiopulmonary bypass times were 155 minutes and 97 minutes, respectively (p=0.064), and aortic cross clamp times were 122 minutes and 64 minutes, respectively (p=0.004). On average, patients with maze spent 3.7 more days in the hospital compared to those without maze (p=0.001). Conclusions: Performing a concomitant maze procedure in patients undergoing TOF repair was associated with a moderate improvement in atrial tachyarrhythmia burden over 2 years. TOF patients who had the concomitant maze procedure required longer cardiopulmonary bypass time, aortic cross clamp time, and total hospital stay.

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Micro-reentry right atrial tachycardia originating from fossa ovalis: a case report of high-density mapping by PentaRay catheter

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz141 ◽

2019 ◽

Vol 3 (3) ◽

Author(s):

Jin-Yi Li ◽

Xiang-Wei Lv ◽

Guo-Qiang Zhong ◽

Hong-Hong Ke

Keyword(s):

Atrial Tachycardia ◽

Mapping Method ◽

High Density ◽

Right Atrial ◽

Ablation Therapy ◽

Density Mapping ◽

Mapping System ◽

Conventional Mapping ◽

Electrophysiological Examination

Abstract Background Micro-reentry tachycardia usually emerges in scar tissues related to post-atrial fibrillation ablation and cardiomyopathy. It is difficult to identify the micro-reentry circuit accurately by conventional mapping method. Case summary A 74-year-old man presented with paroxysmal atrial tachycardia (AT) presenting as palpitations. He was evaluated by an electrophysiological examination using a high-density CARTO mapping system. The mapping results showed the AT with a cycle length of 184 ms was focused on his right atrial fossa ovalis (FO). In this small area, the high-density mapping demonstrated a significant micro-reentrant tachycardia. Radiofrequency ablation at the centre of the micro-reentrant circuit successfully terminated the AT. No recurrences were observed during a 12-month follow-up. Discussion This case demonstrated a micro-reentrant AT originates from the FO without cardiomyopathy or previous ablation with specific loops. This is an unusual location for AT though and can cause difficulty for operators if it terminates or is non-sustained. High-density mapping using a PentaRay catheter can effectively characterize micro-reentrant circuits and determine the real target for ablation therapy.

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Effect of Mitral Isthmus Block on Development of Atrial Tachycardia Following Ablation for Atrial Fibrillation

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2009.02625.x ◽

2010 ◽

Vol 33 (4) ◽

pp. 460-468 ◽

Cited By ~ 45

Author(s):

RAMTIN ANOUSHEH ◽

NAVINDER S. SAWHNEY ◽

MICHAEL PANUTICH ◽

CHARLES TATE ◽

WEI-CHUNG CHEN ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrial Tachycardia ◽

Mitral Isthmus ◽

Isthmus Block

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Early outcomes of usage of cryoFORM® probe for cryomaze procedure in congenital heart surgery

Cardiology in the Young ◽

10.1017/s1047951120003029 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1874-1879

Author(s):

Firat H. Altin ◽

Sevket Balli ◽

Murat Cicek ◽

Okan Yurdakok ◽

Oktay Korun ◽

...

Keyword(s):

Congenital Heart ◽

Heart Surgery ◽

Heart Diseases ◽

Electrophysiological Study ◽

Congenital Heart Surgery ◽

Maze Procedure ◽

Right Atrial ◽

Complex Anatomy ◽

Pacemaker Placement ◽

The Right

AbstractObjectives:This study aimed to evaluate the early outcomes of patients who underwent a concomitant therapeutic maze procedure for congenital heart surgery.Materials and Methods:Between 2019 and 2020, eight patients underwent surgical cryoablation by using the same type of cryoablation probe.Results:Three patients had atrial flutter, two had Wolf–Parkinson–White syndrome, two intra-atrial reentrant tachycardia, and one had atrial fibrillation. Four patients underwent electrophysiological study. Preoperatively, one patient was on 3, two were on 2, five were on 1 antiarrhythmic drug. Six patients underwent right atrial maze and two underwent bilateral atrial maze. Five out of six right atrial maze patients underwent right atrial reduction. Nine different lesion sets were used. Some of the lesions were combined and applied as one lesion. In Ebstein’s anomaly patients, the lesion from coronary sinus to displaced tricuspid annulus was delicately performed. The single ventricle patient with heterotaxy had junctional rhythm at the time of discharge and was the only patient who experienced atrial extrasystoles 2 months after discharge. Seven of the eight patients were on sinus rhythm. No patient needed permanent pacemaker placement.Conclusion:Cryomaze procedure can be applied in congenital heart diseases with acceptable arrhythmia-free rates by selecting the appropriate materials and suitable lesion sets. The application of cryomaze in heterotaxy patients can be challenging due to differences in the conduction system and complex anatomy. Consensus with the electrophysiology team about the choice of the right–left or biatrial maze procedure is mandatory for operational success.

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