• Circ Arrhythm Electrophysiol · Feb 2015

    Left septal atrial tachycardia after open-heart surgery: relevance to surgical approach, anatomical and electrophysiological characteristics associated with catheter ablation, and procedural outcomes.

    • Toru Adachi, Kentaro Yoshida, Noriyuki Takeyasu, Keita Masuda, Yukio Sekiguchi, Akira Sato, Hiroshi Tada, Akihiko Nogami, and Kazutaka Aonuma.
    • From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (T.A., K.Y., N.T., K.M., Y.S., A.S., A.N., K.A.); and Division of Cardiovascular Medicine, University of Fukui, Yoshida-gun, Japan (H.T.).
    • Circ Arrhythm Electrophysiol. 2015 Feb 1;8(1):59-67.

    BackgroundSeptal atrial tachycardia (AT) can occur in patients without structural heart disease and in patients with previous catheter ablation of atrial fibrillation. We aimed to assess septal AT that occurs after open-heart surgery.Methods And ResultsThis study comprised 20 consecutive patients undergoing catheter ablation of macroreentrant AT after open-heart surgery. Relevance to surgical approach, mechanisms, anatomic and electrophysiological characteristics, and outcomes were assessed. Septal AT was identified in 7 patients who had all undergone mitral valve surgery. All septal ATs were localized in the left atrial septum, whereas 10 of 13 nonseptal ATs originated from the right atrium. Patients with left septal AT had a thicker fossa ovalis (median, 4.0; 25th-75th percentile, 3.6-4.2 versus 2.3; 1.6-2.6 mm; P=0.006) and broader area of low voltage (<0.3 mV) in the septum than patients with nonseptal AT (82; 76-89 versus 31; 28%-36%; P=0.02). Repeated gradual prolongations of the tachycardia cycle length without change of the septal circuit were observed in all patients with septal AT (70; 63-100 versus 15; 10-40 ms; P=0.0008). Although ablation terminated all ATs, recurrence of targeted ATs was more frequent in patients with left septal AT during 30-month follow-up (71 versus 0%; P=0.001).ConclusionsLeft septal AT after open-heart surgery was characterized by a thicker septum, more scar burden in the septum, and repeated prolongations of the tachycardia cycle length during ablation. Such an arrhythmogenic substrate may interfere with transmural lesion formation by ablation and may account for higher likelihood of recurrence of left septal AT.© 2014 American Heart Association, Inc.

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