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Ann Thorac Surg 2007;83:1717-1723
© 2007 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Prevention of Atrial Flutter With Cryoablation May Be Proarrhythmogenic

Peter Lukac, MD, PhDa,*, Vibeke E. Hjortdal, MD, PhDb, Anders K. Pedersen, MD, DMSca, Peter T. Mortensen, MDa, Henrik K. Jensen, MD, PhDa, Peter S. Hansen, MD, PhDa

a Department of Cardiology, Skejby University Hospital, Aarhus, Denmark
b Department of Cardio-Thoracic Surgery, Skejby University Hospital, Aarhus, Denmark

Accepted for publication January 12, 2007.

* Address correspondence to Dr Lukac, Department of Cardiology, Skejby Hospital, Brendstrupgaardsvej, DK-8200 Aarhus N, Denmark (Email: lukacpe2{at}hotmail.com).

Background: Atrial flutter is a serious problem after surgery for congenital heart disease.

Methods: We performed an intraoperative linear one-minute cryolesion between a right atriotomy and the tricuspid annulus to prevent atrial flutter in 17 consecutive adult patients undergoing surgery for congenital heart disease. Coronary angiography and electrophysiology study using an electroanatomic mapping system to assess the conduction across the line and to try to induce atrial flutter were performed three months after the operation in 15 patients.

Results: Eleven patients had bidirectional block in the cryolesion, four patients did not, and two patients refused the electrophysiology study and coronary angiography. All patients with terminal temperature below –151°C had bidirectional block, while only one patient with terminal temperature above –151°C had bidirectional block. No patient with bidirectional block and all patients without bidirectional block had inducible or spontaneous atrial flutter (p = 0.0007). No lesion of the right coronary artery was detected at coronary angiography.

Conclusions: The success rate was suboptimal and the intervention is potentially proarrhythmogenic in patients without block. Preventive strategies targeting atrial flutter should be validated with regard to the block rate achieved.


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Invited commentary
G. Hossein Almassi
Ann. Thorac. Surg. 2007 83: 1723. [Extract] [Full Text] [PDF]



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G. H. Almassi
Invited commentary
Ann. Thorac. Surg., May 1, 2007; 83(5): 1723 - 1723.
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