Abstract
Background
The superior transseptal approach (STA) for mitral valve surgery is associated with a higher risk of developing macroreentrant incisional atrial flutter (AFL) than the left atrial approach. This study aimed to describe the linear lesions for the complex AFL circuit after the STA and to propose an option for the linear ablation target site.
Methods
Of the 26 patients who underwent radiofrequency catheter ablation for AFL after mitral valve surgery, data from seven patients with STA incisions were retrospectively analyzed.
Results
All patients who had undergone the STA had incisional AFL rotated in a long loop within the right atrium (RA) and cavo-tricuspid isthmus (CTI)-dependent AFL. The linear lesions were created in the CTI, the superior RA vestibule, and between the RA-free wall incision or the septal incision and the inferior vena cava. Procedural success was achieved with dual linear lesions in the CTI and superior RA vestibule. Two of seven patients had AFL recurrence during a mean observation period of 22.5 ± 16.7 months. The circuits of recurrent AFL were CTI-dependent AFL and perimitral AFL, respectively. No AFL recurrence was noted with reconduction of the superior RA vestibular lesion.
Conclusion
Dual linear lesions in the CTI and superior RA vestibule are an effective treatment option for RA macroreentrant AFL after the STA.
Graphical Abstract
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Data availability
The data supporting the findings of this study are available from the corresponding author, Toshio Makita, upon reasonable request.
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All authors contributed to the study conception and design. Taishi Kuwahara made significant contributions to the design of the work and the interpretation of data. Material preparation, data collection, and analysis were performed by Toshio Makita, Kenta Takahashi, Hirofumi Nakagawa, Yoshimi Oyagai, Kenta Kadono, and Takuya Oshio. The first draft of the manuscript was written by Toshio Makita and all authors commented on previous versions of the manuscript. All authors approved the submitted version of the manuscript and agreed to be accountable for any part of the work.
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Makita, T., Kuwahara, T., Takahashi, K. et al. Dual linear lesions for right atrial flutter after mitral valve surgery via the superior transseptal approach. J Interv Card Electrophysiol 67, 579–587 (2024). https://doi.org/10.1007/s10840-023-01631-8
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DOI: https://doi.org/10.1007/s10840-023-01631-8