TY - JOUR

T1 - Prevention of atrial flutter with cryoablation may be proarrhythmogenic

AU - Lukac, Peter

AU - Hjortdal, Vibeke E

AU - Pedersen, Anders K

AU - Mortensen, Peter T

AU - Jensen, Henrik K

AU - Hansen, Peter S

PY - 2007/5

Y1 - 2007/5

N2 - BACKGROUND: Atrial flutter is a serious problem after surgery for congenital heart disease.METHODS: We performed an intraoperative linear one-minute cryolesion between a right atriotomy and the tricuspid annulus to prevent atrial flutter in 17 consecutive adult patients undergoing surgery for congenital heart disease. Coronary angiography and electrophysiology study using an electroanatomic mapping system to assess the conduction across the line and to try to induce atrial flutter were performed three months after the operation in 15 patients.RESULTS: Eleven patients had bidirectional block in the cryolesion, four patients did not, and two patients refused the electrophysiology study and coronary angiography. All patients with terminal temperature below -151 degrees C had bidirectional block, while only one patient with terminal temperature above -151 degrees C had bidirectional block. No patient with bidirectional block and all patients without bidirectional block had inducible or spontaneous atrial flutter (p = 0.0007). No lesion of the right coronary artery was detected at coronary angiography.CONCLUSIONS: The success rate was suboptimal and the intervention is potentially proarrhythmogenic in patients without block. Preventive strategies targeting atrial flutter should be validated with regard to the block rate achieved.

AB - BACKGROUND: Atrial flutter is a serious problem after surgery for congenital heart disease.METHODS: We performed an intraoperative linear one-minute cryolesion between a right atriotomy and the tricuspid annulus to prevent atrial flutter in 17 consecutive adult patients undergoing surgery for congenital heart disease. Coronary angiography and electrophysiology study using an electroanatomic mapping system to assess the conduction across the line and to try to induce atrial flutter were performed three months after the operation in 15 patients.RESULTS: Eleven patients had bidirectional block in the cryolesion, four patients did not, and two patients refused the electrophysiology study and coronary angiography. All patients with terminal temperature below -151 degrees C had bidirectional block, while only one patient with terminal temperature above -151 degrees C had bidirectional block. No patient with bidirectional block and all patients without bidirectional block had inducible or spontaneous atrial flutter (p = 0.0007). No lesion of the right coronary artery was detected at coronary angiography.CONCLUSIONS: The success rate was suboptimal and the intervention is potentially proarrhythmogenic in patients without block. Preventive strategies targeting atrial flutter should be validated with regard to the block rate achieved.

KW - Adult

KW - Atrial Flutter/complications

KW - Cardiac Surgical Procedures/adverse effects

KW - Cryosurgery/adverse effects

KW - Feasibility Studies

KW - Female

KW - Heart Block/complications

KW - Heart Defects, Congenital/surgery

KW - Humans

KW - Male

KW - Middle Aged

KW - Prospective Studies

U2 - 10.1016/j.athoracsur.2007.01.022

DO - 10.1016/j.athoracsur.2007.01.022

M3 - Journal article

C2 - 17462387

VL - 83

SP - 1717

EP - 1723

JO - The Annals of Thoracic Surgery

JF - The Annals of Thoracic Surgery

SN - 0003-4975

IS - 5

ER -