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CLINICAL STUDIES

Mechanism, localization and cure of atrial arrhythmias occurring after a new intraoperative endocardial radiofrequency ablation procedure for atrial fibrillation

Stuart P. Thomas, BMed, FRACP^a, Graham R. Nunn, MB, BS, FRACS^b, Ian A. Nicholson, MB, BS, FRACS^b, Arianwen Rees, BSc^a, Michael P. J. Daly, PhD, BEng, Richard B. Chard, MB, BS, FRACS^b and David L. Ross, MB, BS, FRACP^a

^a Department of Cardiology, Westmead Hospital, Westmead, NSW Australia2145
^b Department of Surgery, Westmead Hospital, Westmead, NSW Australia2145
Cooperative Research Centre for Cardiac Technology, Westmead Hospital, Westmead, NSW Australia2145

Manuscript received November 16, 1998; revised manuscript received August 24, 1999, accepted October 18, 1999.

Reprint requests and correspondence: Professor David L. Ross, Director, Department of Cardiology, Westmead Hospital, Westmead, NSW Australia 2145
davidr{at}westmed.wh.usyd.edu.au

OBJECTIVES

The purpose of this study was to test a new pattern of radiofrequency ablation for atrial fibrillation (AFib) intended to optimize atrial activation, and to demonstrate the usefulness of catheter techniques for mapping and ablation of postoperative atrial arrhythmias.

BACKGROUND

Linear radiofrequency lesions have been used to cure AFib, but the optimal pattern of lesions is unknown and postoperative tachyarrhythmias are common.

METHODS

A radial pattern of linear radiofrequency lesions (Star) was made using an endocardial open surgical approach in 25 patients. Postoperative arrhythmias were induced and characterized during electrophysiological studies in 15 patients.

RESULTS

The AFib was abolished in most patients (91%), but atrial flutter (AFlut) occurred in 96% of patients postoperatively. At postoperative electrophysiological studies, 37 flutter morphologies were studied in 15 patients (46% spontaneous, cycle length [CL] 223 ± 25 ms). Seven mechanisms (lesions discontinuity, n = 6; focal mechanism, n = 1) of AFlut were characterized in six patients. In these cases, flutter was abolished using further catheter radiofrequency ablation. In the remaining cases, flutter was usually localized to an area involving the interatrial septum, but no critical isthmus was identified for ablation. After 16 ± 10 months, 15 patients (65%) were asymptomatic with (n = 3) or without (n = 12) antiarrhythmic medications. Eight (35%) patients had persistent arrhythmias. Postoperative atrial electrical activation was near physiological.

CONCLUSIONS

The AFib may be abolished using a radial pattern of linear endocardial radiofrequency lesions, but postoperative AFlut is common even when lesions are made under optimal conditions. Endocardial mapping techniques can be used to characterize the flutter mechanisms, thus enabling subsequent successful catheter ablation.

Abbreviations and Acronyms   AFib = atrial fibrillation   AFlut = atrial flutter   CL = cycle length   TA = tricuspid annulus

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