Key result
High-resolution mapping of 36 post-Maze atrial tachycardias in 20 patients revealed that 61.1% were anatomical macro-reentrant ATs, primarily driven by surgical incisions and lesions.
Why the study?
Atrial tachycardias frequently develop after a surgical Maze procedure, but their electrophysiologic mechanisms and arrhythmogenic substrates require elucidation.
Observational (n=20)
Yes
Reentry is the primary mechanism of post-Maze atrial tachycardias, with pro-arrhythmic substrates largely driven by surgical incisions and lesions creating slow conduction regions.
BACKGROUND: Atrial tachycardias (ATs) frequently develop after a surgical Maze procedure. We aimed to elucidate the electrophysiologic mechanisms and their arrhythmogenic substrates of these ATs. METHODS AND RESULTS: We retrospectively reviewed 20 patients (14 females, mean age of 55.5 ± 8.6 years) with post-Maze ATs who underwent high-resolution mapping at three institutions. The slow conduction areas, reentry circuits, voltage signals, complex electrograms, and their correlation with the surgical incisions and lesions placed in the surgical Maze procedures were analyzed. Thirty-six ATs with a mean cycle length of 260.0 ± 67.6 ms were mapped in these patients. Among them, 22 (61.1%) were anatomical macro-reentrant ATs (AMAT), 12 (33.3%) non-AMATs (localized ATs), and 2 (5.6%) focal ATs, respectively. Epicardial conduction bridges were observed in 6/20 (30.0%) patients and 7/36 (19.4%) ATs. Different arrhythmogenic substrates were identified in these ATs, including slow conduction regions within the previous lesion areas or between the incisions and anatomical structures, the prolonged activation pathways caused by the short lesions connecting the tricuspid annulus, and the circuits around the long incisions and/or lesions. CONCLUSIONS: Reentry is the main mechanism of the post-Maze ATs. The pro-arrhythmic substrates are most likely caused by surgical incisions and lesions. The slow conduction regions and the protected channels yielded from these areas are the major arrhythmogenic factors.
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Hu et al. (2022) conducted an observational in post-Maze atrial tachycardias (n=20). Surgical Maze procedure was evaluated on Electrophysiologic mechanisms and arrhythmogenic substrates of post-Maze ATs. High-resolution mapping of 36 post-Maze atrial tachycardias in 20 patients revealed that 61.1% were anatomical macro-reentrant ATs, primarily driven by surgical incisions and lesions.
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