Author + information
- Received January 9, 2018
- Revision received July 3, 2018
- Accepted July 6, 2018
- Published online November 19, 2018.
- Yumei Xue, MDa,b,∗,
- Yang Liu, MDa,b,c,∗,
- Hongtao Liao, MDa,b,
- Xianzhang Zhan, MDa,b,
- Xianhong Fang, MDa,b,
- Hai Deng, MDa,b,
- Feng Wang, MDa,b,
- Wenxiang Huang, MDa,b,
- Yuanhong Liang, MDa,b,
- Wei Wei, MDa,b,
- Yingjie Huang, MDa,b,
- Zili Liao, MDa,b,
- Michael Shehata, MDc,
- Xunzhang Wang, MDc and
- Shulin Wu, MDa,b,∗ ()
- aGuangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- bGuangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- cHeart Institute, Cedars Sinai Medical Center, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Shulin Wu, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou 510080, China.
Objectives This study aimed to evaluate the electrophysiological mechanisms of post-surgical atrial tachycardias (ATs) during mapping with an automated high-resolution mapping system (Rhythmia, Boston Scientific, Marlborough, Massachusetts).
Background Mapping and ablation of post-operative ATs following previous open-heart surgery is often challenging because the potential mechanisms remain incompletely understood.
Methods Fifty-one consecutive patients underwent mapping and ablation of post-surgical ATs.
Results A total of 64 ATs were identified, and the mechanism was macro re-entry in 58 of 63 (92.1%) ATs, focal in 4 ATs, localized micro re-entry in 1 AT, and undetermined in 1 AT. Of 11 patients who underwent surgical repair of congenital heart disease, 6 (54.5%) had peri-tricuspid re-entrant AT, 5 had either right atrial (RA) free-wall incisional ATs or figure-8 re-entrant ATs, with an isthmus between the tricuspid annulus and the RA free-wall incision or between the incisions, and none had left atrial (LA) or focal ATs. In 32 patients with valve replacement and 8 who underwent valvuloplasty, peri-tricuspid ATs were observed in 14 (43.4%) and 6 (75%) patients, RA free wall or septal incisions-related ATs were seen in 7 and 2 patients, and LA macro re-entrant ATs were observed in 12 patients and 1 patient, respectively. A macro pseudo re-entry pattern was identified in 8 of 51 patients (15.7%). All these activations could be easily excluded by manually moving the window of interest, except in 2 cases with a figure-8 re-entrant configuration.
Conclusions RA macro re-entrant ATs predominate, irrespective of the types of initial surgical procedures, but LA ATs occur more frequently in patients with valve replacement. Pseudo re-entry atrial activation is common and easily recognized by adjusting the mapping window.
↵∗ Drs. Xue and Liu contributed equally to this article, and are joint first authors.
Dr. Liu is supported by research grants from the National Natural Science Foundation of China (NSFC-81400259) and Guangdong Province (2014A030310470). Dr. Wu is supported by research grants from the Science and Technology Programs of Guangdong Province (No. 2014B070705005) and Guangzhou City (No. 201508020261). Dr. Yang Liu has received an educational fee from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received January 9, 2018.
- Revision received July 3, 2018.
- Accepted July 6, 2018.
- 2018 American College of Cardiology Foundation