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Relationship between electrical gap after Maze procedure and atrial arrhythmia and ablation outcome after cardiac surgery and concomitant Maze procedure.
  • +15
  • Keisuke Suzuki,
  • Koji Miyamoto,
  • Ueda Nobuhiko,
  • Kenzaburo Nakajima,
  • Tsukasa Kamakura,
  • Mitsuru Wada,
  • Kennichiro Yamagata,
  • Kohei Ishibashi,
  • Yuko Inoue,
  • Takashi Noda,
  • Satoshi Nagase,
  • Takeshi Aiba,
  • Tomoyuki Yambe,
  • Takashi Kakuta,
  • Naoki Tadokoro,
  • Satsuki Fukushima,
  • Tomoyuki Fujita,
  • Kengo Kusano
Keisuke Suzuki
National Cerebral and Cardiovascular Center
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Koji Miyamoto
National Cerebral and Cardiovascular Center
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Ueda Nobuhiko
National Cerebral and Cardiovascular Center
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Kenzaburo Nakajima
National Cerebral and Cardiovascular Center
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Tsukasa Kamakura
National Cerebral and Cardiovascular Center
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Mitsuru Wada
National Cerebral and Cardiovascular Center
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Kennichiro Yamagata
National Cerebral and Cardiovascular Center
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Kohei Ishibashi
National Cerebral and Cardiovascular Center
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Yuko Inoue
National Cerebral and Cardiovascular Center
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Takashi Noda
National Cerebral and Cardiovascular Center
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Satoshi Nagase
National Cerebral and Cardiovascular Center
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Takeshi Aiba
National Cerebral and Cardiovascular Center
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Tomoyuki Yambe
Institute of Development, Aging and Cancer, Tohoku University
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Takashi Kakuta
National Cerebral and Cardiovascular Center
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Naoki Tadokoro
National Cerebral and Cardiovascular Center
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Satsuki Fukushima
National Cerebral and Cardiovascular Center
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Tomoyuki Fujita
National Cerebral and Cardiovascular Center
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Kengo Kusano
National Cerebral and Cardiovascular Center
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Abstract

Introduction: There are few reports of the characteristics, mechanisms, and outcomes of atrial tachycardia (AT) and atrial fibrillation (AF) ablation after cardiac surgery and concomitant Maze procedures. This study investigated the mechanisms and long-term outcomes of AT and AF ablation after various Maze procedures, especially we examined in detail whether the arrhythmia after Maze procedure was due to gap or not. Methods and Results: We analyzed 37 consecutive cases with AT and AF after cardiac surgery and Maze procedure between 2007 and 2019. Fifty-nine atrial arrythmias were induced in 37 consecutive cases, and 49 of those atrial arrythmias were mappable ATs. Forty-two ATs was related to the Maze procedure in the 49 mappable ATs (87.5%). All 37 consecutive cases had residual electrical conductions (gaps) in the Maze lines (88 gaps; 2.4±1.2 gaps/patient). Forty-two of 88 gaps (47.7%) were associated with gap-related ATs. The most common gap-related ATs in this study were peri-mitral atrial flutter in 22 cases. The median follow-up period after ablation was 3.6±3.2 years (median, 2.1 years; interquartile range, 0.89-6.84). The Kaplan-Meier analysis of freedom from recurrent atrial arrhythmia after Maze procedure was 79.9% at 1-year follow up and 69.3% at 4-year follow up. Conclusions: Reentry was the main mechanism of AT after cardiac surgery and concomitant various Maze procedures, and AT were largely related to the gap in the Maze line between mitral valve anulus and pulmonary vein isolation line. Catheter ablation of AT after various Maze procedures seemed to be effective and safe during long-term follow-up.