Chen Hongwu, Yang Bing, Ju Weizhu, Zhang Fengxiang, Gu Kai, Li Mingfang, Wang Jing, Cao Kejiang, Chen Minglong
Section of Electrophysiology, Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Pacing Clin Electrophysiol. 2013 Jul;36(7):795-802. doi: 10.1111/pace.12153. Epub 2013 Jun 6.
Atrial tachycardia (AT) is a frequent late sequel of surgical valve replacement procedures in patients with rheumatic heart disease (RHD). The aim of this study was to evaluate the acute and long-term outcome of catheter ablation in such patients.
A total of 21 consecutive RHD patients with AT after a valve replacement were enrolled in this study. The mean interval between the occurrence of symptomatic AT and the surgical intervention was 38.2 ± 48.7 months. The initial procedure was performed 8.4 ± 8.9 months after first onset of AT. During the first procedure, an electroanatomic mapping was completed for 25 ATs, 18 of which were cavotricuspid isthmus-dependent atrial flutter, five that were right atrial free wall AT, and two that were left AT. Acute success was obtained in 95% (20/21) patients. Nine patients with recurrent AT had repeat radiofrequency catheter ablation, and newly developed left AT was identified in five patients after the first right AT ablation. After a mean follow-up of 42.7 ± 17.3 months, only 33% of the patients remained free of ATs, while 14% and 53% of the patients had AT recurrence and the development of atrial fibrillation (AF), respectively.
Right but not left macroreentry is the most common AT postmitral valve replacement in patients with RHD. The incidence of AF is very high after AT ablation in such patients during the long-term follow-up.
