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Risk factors and Management of Mitral Annular Atrial Flutter After Mitral Valve Surgery

  • Arrhythmias (J. Bunch, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Macro-reentrant atrial tachycardias can occur in many patients after cardiac valve surgery. This review highlights the risk factors and special considerations for managing mitral annular flutter after mitral valve surgery.

Recent Findings

Perimitral annular flutter wavefront usually rotates clockwise or counterclockwise, supported by endocardial structures and low-voltage, slow conduction areas. Recent studies have shown the benefits of a steerable sheath while manipulating it near the mitral valve and multipolar mapping catheter to confirm PV isolation, which is necessary to ensure enduring blocks across the mitral isthmus. Integration of the latest high-density mapping techniques with fluoroscopic images into diagnostic evaluation helps better delineate the flutter circuit and reduce the risk of radiation exposure and complications like catheter entrapment.

Summary

In mitral valve surgery patients, mitral annular flutter is not uncommon. Hybrid thoracoscopic surgical techniques with subsequent percutaneous catheter-based ablation have been shown to reduce the cumulative risk of post-combined procedure risk of perimitral annular flutter. The details of surgical methods by the cardiothoracic surgical team might help better delineate the mechanisms of mitral annular flutter.

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Abbreviations

AF:

Atrial fibrillation

AFL:

Atrial flutter

AAFL:

Atypical atrial flutter

AAD:

Antiarrhythmic drugs

BB:

Bachman bundle

CS:

Coronary sinus

CD:

Charge density

CMP:

Cox maze procedure

EGM:

Electrogram

FDG:

F-fluorodeoxyglucose

LAAW:

Left atrial anterior wall

LMIL:

Lateral mitral isthmus line

LAT:

Local activation time

MAT:

Mitral annular tachycardia

MAF:

Mitral annular flutter

SMIL:

Septal mitral isthmus line

VA:

Ventricular arrhythmia

VT:

Ventricular tachycardia

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This research did not receive any specific grant from funding agencies in public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Cardiovascular Diseases, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA

    Anil Sriramoju, Mostafa Elbanna, Kamal Preet Cheema, Nway Le Ko Ko & Komandoor Srivathsan

Authors
  1. Anil Sriramoju
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  2. Mostafa Elbanna
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  3. Kamal Preet Cheema
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  4. Nway Le Ko Ko
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  5. Komandoor Srivathsan
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Correspondence to Komandoor Srivathsan.

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Drs Sriramoju, Elbanna, Cheema, Ko Ko and Srivathsan declare that they have no conflict of interest.

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Sriramoju, A., Elbanna, M., Cheema, K.P. et al. Risk factors and Management of Mitral Annular Atrial Flutter After Mitral Valve Surgery. Curr Cardiovasc Risk Rep 16, 87–96 (2022). https://doi.org/10.1007/s12170-022-00696-w

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  • DOI: https://doi.org/10.1007/s12170-022-00696-w

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