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Arrhythmogenesis of surgical atrial incisions and lesions in Maze procedure: insights from high-resolution mapping of atrial tachycardias

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机构: [1]Cardiology Department, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China [2]Cardiology Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China [3]Cardiology Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China [4]School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China [5]Cardiology Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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关键词: Atrial tachycardia Reentry Maze procedure Surgical Mapping High-resolution

摘要:
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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出版当年[2022]版:
大类 | 2 区 医学
小类 | 2 区 心脏和心血管系统
最新[2025]版:
大类 | 1 区 医学
小类 | 2 区 心脏和心血管系统
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出版当年[2021]版:
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
最新[2023]版:
Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

影响因子: 最新[2023版] 最新五年平均 出版当年[2021版] 出版当年五年平均 出版前一年[2020版] 出版后一年[2022版]

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第一作者机构: [1]Cardiology Department, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China [2]Cardiology Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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通讯机构: [2]Cardiology Department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China [5]Cardiology Department, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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