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Atrial flutter after surgical maze: incidence, diagnosis, and management

Dresen, William; Mason, Pamela K.

Current Opinion in Cardiology: January 2016 - Volume 31 - Issue 1 - p 57–63
doi: 10.1097/HCO.0000000000000239
ARRHYTHMIAS: Edited by David H. Birnie
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Purpose of review The prevalence of atrial fibrillation is increasing and surgical ablation is becoming more common, both as a stand-alone procedure and when performed concomitantly with other cardiac surgery. Although surgical ablation is effective, with it unique challenges arise, including iatrogenic macroreentrant tachycardias that are often highly symptomatic and difficult to manage conservatively.

Recent findings Postsurgical ablation, localization of the arrhythmic circuit is difficult to determine using surface ECG alone because of alterations in the atrial myocardium, and multiple different pathways are often present. Most, however, localize to the left atrium, and percutaneous catheter ablation is emerging as an effective treatment modality.

Summary Patients with complex postoperative arrhythmias should be referred to a dedicated atrial fibrillation center when possible and symptomatic arrhythmias mapped and ablated. Knowledge of the previously performed surgical lesion set is of vital importance in understanding the mechanism of the arrhythmia and increasing procedural success rates.

Video abstract http://links.lww.com/HCO/A31.

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Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA

Correspondence to Pamela K. Mason, MD, Division of Cardiology, University of Virginia, PO Box 800158, Charlottesville, VA 22908, USA. Tel: +1 34 924 2465; fax: +1 434 982 1998; e-mail: pkm5f@virginia.edu

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