Catheter Ablation of Regular Atrial Arrhythmia Following Surgical Treatment of Permanent Atrial Fibrillation

Introduction: Surgical treatment of atrial fibrillation (AF) is gaining widespread acceptance. However, therapeutic modalities for secondary regular atrial tachycardia are still empiric. Methods and Results: After linear atrial cooled‐tip radiofrequency ablation (SICTRA) during cardio‐surgical procedures to cure permanent AF, patients with regular atrial tachycardia were identified. Invasive electrophysiology including electroanatomic mapping was performed. Catheter ablation was directed to suppress atrial arrhythmia depending on activation mapping findings. Follow‐up was performed after 3 months and then after every 6 months. Of 238 patients, 12 (5.0%) were identified with regular secondary arrhythmias (12 ± 7 months after surgery) including 9 (3.8%) with persistent forms originating from the right atrium (RA) in six (66%) (isthmus‐dependent macroreentry in 4, incisional macroreentry in 1, and RA ectopy in 1). All patients with RA origin of the tachycardia were successfully ablated. Two patients had left atrial (LA)‐macroreentry circling around the mitral valve indicating insufficiency of the intraoperative ablation procedure: one patient was successfully ablated within the LA isthmus, in the other patient no complete conduction block could be induced. One patient had LA‐macroreentry degenerating into AF, and ablation was not performed. During follow‐up (9 ± 4 months), no recurrences of atrial tachycardias were documented after successful ablation. Conclusions: Persistent regular “secondary” arrhythmia occurred in 3.8% (9/238) of patients after SICTRA to treat permanent AF. Predominantly (67%; 6/9), the arrhythmia was located in the RA mostly incorporating the RA‐isthmus. Catheter ablation was highly effective for RA tachycardia (100%). In three cases (33%), LA‐macroreentry was documented and catheter ablation was successful in only one patient (overall success 78%).