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LA Flutter as a Complication of the MAZE Procedure Using Cryoablation for Treatment of Paroxysmal and Permanent AF in Patients Undergoing Concomitant Cardiac Surgery
Samir Redzepagic, Alex Rosalion.
St Vincents Hospital Melbourne, Maidstone, Australia.

OBJECTIVE: The objective of this study was to evaluate the incidence of LA flutter as one of the complications of the MAZE procedure using cryoablation for treatment of paroxysmal and permanent atrial fibrillation (AF) in patients undergoing concominant cardiac surgery. We sought to identify the predictors of failure for this particular tachyarrhythmia and recognize the patterns in order to avoid this complication in MAZE procedure.
METHODS: : From July 2003 to Dec 2010 227 consecutive patients (mean age 73.1 years) who underwent cryoablation for AF were evaluated and divided into 2 groups. Group A the left sided cryo Maze for paroxysmal AF (n=119) and Group biatrial cryo Maze for permanent AF (n=108). 17(6.74%) patients out of 227 presented with symptomatic LA flutter and 10(5.1%) of them were from Group A while 7(8.75%) from Group B. EP studies were conducted in all of them.
RESULTS: : From July 2003 to Dec 2010 227 consecutive patients (mean age 73.1 years) who underwent cryoablation for AF were evaluated and divided into 2 groups. Group A the left sided cryo Maze for paroxysmal AF (n=119) and Group biatrial cryo Maze for permanent AF (n=108). 17(6.74%) patients out of 227 presented with symptomatic LA flutter and 10(5.1%) of them were from Group A while 7(8.75%) from Group B. EP studies were conducted in all of them.
CONCLUSIONS: The cryoablation for paroxysmal and permanent AF in patients undergoing concomitant cardiac surgery is safe and effective but certain subset experience symptomatic atrial arrhythmias which must be addressed and treated in EP lab. We were able to demonstrate that in some patients with paroxysmal AF presenting with LA flutter incomplete lesion set or additional ablation lines may be responsible for success or failure, while in patients with permanent AF mitral valve annulus ablation line and size of the left atrium(consider reducing) are the two factors most likely to impact on LA flutter. The combination of two modalities, catheter and surgical ablation, can improve the outcome even in complex patients.


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