Dual linear lesions for right atrial flutter after mitral valve surgery via the superior transseptal approach

Abstract

Background: The superior transseptal approach (STA) for mitral valve surgery is associated with a higher risk of developing macroreentrant incisional atrial flutter (AFL) than the left atrial approach. This study aimed to describe the linear lesions for the complex AFL circuit after the STA and to propose an option for the linear ablation target site.

Methods: Of the 26 patients who underwent radiofrequency catheter ablation for AFL after mitral valve surgery, data from seven patients with STA incisions were retrospectively analyzed.

Results: All patients who had undergone the STA had incisional AFL rotated in a long loop within the right atrium (RA) and cavo-tricuspid isthmus (CTI)-dependent AFL. The linear lesions were created in the CTI, the superior RA vestibule, and between the RA-free wall incision or the septal incision and the inferior vena cava. Procedural success was achieved with dual linear lesions in the CTI and superior RA vestibule. Two of seven patients had AFL recurrence during a mean observation period of 22.5 ± 16.7 months. The circuits of recurrent AFL were CTI-dependent AFL and perimitral AFL, respectively. No AFL recurrence was noted with reconduction of the superior RA vestibular lesion.

Conclusion: Dual linear lesions in the CTI and superior RA vestibule are an effective treatment option for RA macroreentrant AFL after the STA.

Keywords: Atrial flutter; Catheter ablation; Mitral valve surgery; Right atrial vestibule; Superior transseptal approach.