Clinical characteristics and ablation outcomes of recurrent atrial tachyarrhythmia after maze operation -a multicenter study in a single city

Abstract

Abstract Backgrounds Catheter ablation of atrial tachyarrhythmia after Maze operation is challenging. 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. Median interval between surgery and index ablation was 35 months. In total, 46 atrial tachyarrhythmias were studied. Atrial tachycardia (AT) was the most common (n=36), whereas 4 atrial fibrillation (AF) and 2 focal AT were also observed. Identified tachyarrhythmia circuits were as follows; 16 mitral AT, 9 left atrial localized reentry (4 septal, 3 posterior, 1 left atrial appendage, 1 anterior), 6 right atrial lateral incision-related AT, 5 cavo-tricuspid isthmus (CTI)-dependent AT, 3 roof-dependent AT, 2 right atrial localized reentry (1 coronary sinus (CS), 1 CTI), 2 focal AT (1 para His, 1 CS), 1 bi-atrial AT, 1 pulmonary vein tachycardia, and 1 slow-fast AVNRT (Figure 1). Termination of targeted tachyarrhythmia was confirmed 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 (Figure 2). Seven cases underwent multiple sessions (2 2nd sessions, 3 3rd sessions, 2 4th sessions). In these cases, de-novo atrial tachyarrhythmias were detected. Conclusions Most of the tachyarrhythmias after Maze operation were incision/gap-related ATs, among which 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.Maze AT Figure 1Maze AT Figure 2