Posted by steve giddings on September 30, 2002 at 10:59:58:
In Reply to: Problem after the MAZE operation posted by Ozzi Nassar on September 30, 2002 at 10:23:06:
A number of folks who post to the site have had late atrial flutter, including myself. I responded to Henry Alken, who also had post op flutter.
I rarely, if ever, make absolute statements on this web site, but here is my first.
WHATEVER YOU DO, DON'T LET AN EP SPECIALIST WHO HAS NO EXPERIENCE WITH POST MAZE PATIENTS ABLATE YOUR AV NODE.
There is no need to do this and that will largely undo what the maze has accomplished.
Here is part of a post I made MAy 5, 2001, 14:46.04. If you just do a search using my last name, you will find a bunch of others.
Steve Giddings
Late atrial flutter is a reported complication of the maze surgery. It is established typically when one of the cryoablation lines is not extended completely across the coronary sinus. (The coronary sinus is actually the main vein that returns blood that flows through the heart from the coronary arteries back into the right atrium. It has a distinct entry point into the ra separate from both the inferior and superior vena cavae, which return blood circulating throught the rest of the body. This vein (coronary sinus) courses laterally across the back of the heart at the base of both atria. One of the ablation lines extends down the back of the left atrium. If this ablation line is inclomplete across the vein (which can be subjected to local cryoablation locally without risk of rupture) a reentrant pathway can be established that courses across this vein and can allow atrial flutter (but not a. fib.) to develop. If it is precipitated by an ectopic atrial beat which just happens to occur at a location with a direct connection to this loop, and occurs at just the right time in the contractile cycle when the loop is vulnerable. Atrial flutter is subdivided into "usual" and "unusual" subtypes. About 80% of flutter involves a relatively discrete path in the right atrium. That is why localized radiofrequency ablation (RFA) in the right atrium (you don't have to cross the atrial septum) has such a high success rate. Unusual atrial flutter can invlolve several other pathways that are usually much harder to map and ablate. ALthough the flutter that occurs after maze is typically in th "unusual" category, Most cases arise as I described above, and so are amenbale to cure by RFA, by an EP cardiologist who is familiar with this complication of the maze procedure. Cox described this specific complication and its treatment in a recent series. He had two reported cases of this compliocation since ~1995. I was (presumably) the third. McCarthy also describes late flutter as a complication. I believe those in his series wer managed with meds.
- Re: Problem after the MAZE operation Ozzi Nassar 05:29:27 10/01/2002 (1)
- Re: Problem after the MAZE operation Dave Funderburg 17:59:18 10/01/2002 (0)