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Europace 2005 7(1):40-49; doi:10.1016/j.eupc.2004.09.009
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© 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.

Radiofrequency ablation of atrial arrhythmias after previous open-heart surgery

A. Nabar*, C. Timmermans, A. Medeiros, K. Polymeropoulous, H.J.G.M. Crijns and L.M. Rodriguez 1

Department of Cardiology, Cardiovascular Research Institute Maastricht, Academic Hospital Maastricht P.Debyelaan 25, 6202 AZ, Post box 5800, Maastricht, Limburg, The Netherlands

AIM: To report the results of ablation of atrial arrhythmias (AA) after previous open-heart surgery.

METHODS: Nineteen patients [50 ± 11 years, 11 women] underwent ablation of symptomatic AAs after previous open-heart surgery. In 11 patients mapping was performed using conventional multielectrode catheters. In the other eight patients CARTO electro-anatomical mapping system was used to supplement conventional mapping.

RESULTS: After conventional mapping, 10/11 patients (91%) were found to have typical atrial flutter (AFL). The cavotricuspid isthmus was successfully ablated in these 10 patients. CARTO combined with conventional mapping showed that 7 of 8 patients had one macro-reentry right atrial circuit. The remaining patient had two focal atrial tachycardias. CARTO-guided ablation was successful in all eight patients (100%). After follow-up of 12 ± 11 months, 2/18 patients (11%) had recurrence of either the same (n = 1) or a new (n = 1) AA.

CONCLUSIONS: AAs after previous open-heart surgery can be ablated successfully (>90%) with a low recurrence rate (11%) at 1-year follow-up. Typical AFL was found frequently (14/19 patients, 72%). This could be ablated successfully, often, after conventional mapping alone. CARTO helps to uncover peri-scar reentry and guide the ablation by creating a line of block connecting the scar to another landmark (unconventional isthmus).

Key Words: catheter ablation, mapping, tachyarrhythmias, post open-heart surgery tachyarrhythmias

*Corresponding author. Tel.: +31 43 387 5093; fax: +31 43 387 5104. E-mail addressess: ashish_nabar{at}hotmail.com (A. Nabar), lm.rodriguez{at}cardio.unimaas.nl (L.M. Rodriguez).


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