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. 2022 Jun;33(6):1190-1196.
doi: 10.1111/jce.15481. Epub 2022 Apr 10.

Is prophylactic ablation of the cavotricuspid and peri-incisional isthmus justified in patients with postoperative atrial flutter after right atriotomy?

Attila Benak  1 , Peter Kupo  1 , Gabor Bencsik  1 , Attila Makai  1 , Laszlo Saghy  1 , Robert Pap  1
Affiliations

Is prophylactic ablation of the cavotricuspid and peri-incisional isthmus justified in patients with postoperative atrial flutter after right atriotomy?

Attila Benak et al. J Cardiovasc Electrophysiol. 2022 Jun.

Abstract

Background: The two most common postoperative atrial flutter (AFL) circuits after right atriotomy are the cavotricuspid isthmus (CTI) dependent and the lateral, peri-incisional. We investigated whether radiofrequency ablation (RFA) of both circuits results in more favorable long-term outcomes.

Methods: Single-center retrospective cohort study of consecutive patients who underwent RFA of AFL after open-heart surgery. The effect of surgery type and RFA strategy on AFL recurrence was evaluated.

Results: One hundred and forty-two patients (mean age 64.5 ± 12.7 years, 65.% male) were enrolled. Patients with right atrial (RA) flutter (n = 124) were divided into two groups based on the index RFA procedure: only one RA circuit was ablated (Group 1, n = 84, 67.7%) or both the CTI and the peri-incisional circuit ablated (Group 2, n = 40, 32.3%). The previous open-heart surgery was categorized based on the extension of the RA incision: limited (Type A) or extended (Type B) atriotomy. After a mean follow-up of 36 ± 28 months, flutter recurrence was not different among patients with limited RA atriotomy (25% vs. 22% in Groups 1A and 2A, respectively, p = 1.0). However, after type B surgery, ablation of both AFL circuits was associated with a reduced recurrence rate (63% vs. 26% in Groups 1B and 2B, respectively, p = .002).

Conclusions: In patients with postoperative RA flutter after extended right atriotomy, ablation of both the CTI and the peri-incisional isthmus significantly reduces the AFL recurrence rate. Prophylactic ablation of both isthmi, even if not proven to support reentry, is reasonable in this population.

Keywords: atrial flutter; atriotomy; open-heart surgery; radiofrequency ablation.

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Comment in

  • Ready to deploy prophylactics?
    Aktas MK, Steinberg JS. Aktas MK, et al. J Cardiovasc Electrophysiol. 2022 Jun;33(6):1197-1198. doi: 10.1111/jce.15482. Epub 2022 Apr 17. J Cardiovasc Electrophysiol. 2022. PMID: 35362204 No abstract available.

References

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