Simultaneous surgical correction of a common atrium and impure flutter

Incomplete atrioventricular canal complicated by cardiac tamponade and bidirectional shunting in an adult dog

An incomplete atrioventricular (AV) canal with bidirectional shunting and cardiac tamponade in a 6-year-old dog was initially diagnosed echocardiographically as a common atrium. The dog failed to respond to medical therapy and was euthanized. Upon necropsy, the defect was confirmed as an incomplete AV canal. A mechanism for the potential sequence of clinical events demonstrated in this dog is proposed.

Efficacy of intraoperative mapping to optimize the surgical ablation of atrial fibrillation in cardiac surgery

BACKGROUND

Observation during open heart surgery in patients with chronic atrial fibrillation (AF) showed that the activation sequence of the left atrium was regular and that of the right atrium chaotic in most patients. We speculate that the left atrium plays a role as an important electrical driving chamber for AF and by mapping pre-operatively, optimal sites for the cryoablation can be determined to minimize the extensiveness of the cryolesions.

METHODS

Forty patients who underwent cardiac surgery and cryoablation guided by epicardial mapping data to eliminate AF originating from the left atrium were included in this study.

RESULTS

Sustained reentrant movement or repetitive firing from foci located in the right atrium was never observed. Foci or reentry circuits located in the left atrium were clearly identified in 11 cases. Nine of the 11 cases resumed sinus rhythm by placing cryolesions at these sites. Two cases needed a pacemaker implantation. The exact site had not been identified in the 29 remaining cases. In these 29 cases a left atrial posterior longitudinal linear cryoablation was placed. Sinus rhythm resumed in 22 cases. Six cases still remained in AF and a pacemaker was implanted in 1 case. Ultimately, in this series of operations sinus rhythm was resumed in 31 of 40 cases; AF remained in 6 of them and pacemaker implantation was required in 3 cases.

CONCLUSIONS

Mapping was useful to distinguish the two etiologies of the AF to facilitate optimal placement of the cryolesions. Sustained reentrant movement or repetitive firing from foci located in the right atrium was never observed and the left atrium played an important role as the electrical driving chamber for AF.

Intraoperative map-guided operation for chronic atrial fibrillation

Intraoperative map-guided cryoablation for chronic atrial fibrillation and coronary artery bypass grafting were simultaneously performed in a 55-year-old man. Computerized atrial mapping revealed that regular and repetitive electrical discharges originated in the left atrial appendage. Without opening the left atrium, we successfully ablated atrial fibrillation with cryoablation on the epicardium of the left atrial appendage. Thus, intraoperative mapping should facilitate operations for atrial fibrillation.