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Simultaneous surgical treatment of atrial septal defect and atrial flutter using a simple modification of the atrial incision

Published online by Cambridge University Press:  19 August 2008

Dagmar Henglein ,
Bruno Cauchemez  and
Gérard Bloch
Dagmar Henglein*
Affiliation:
Department of Cardiovascular surgery, Hôpital Larboisière, Paris, France
Bruno Cauchemez
Affiliation:
Department of Cardiology, Hôpital Larboisière, Paris, France
Gérard Bloch
Affiliation:
Department of Cardiovascular surgery, Hôpital Larboisière, Paris, France
*
Dr Dagmar Henglein MD, Hôpital Lariboisière, 6 rue Ambroise Paré, Service de Chirurgie Cardio-vasculaire, 75010 Paris, France. Tel: (33) (1) 49956591; fax: (33) (1) 49958632.
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Abstract

The reentrant circuit of common atrial flutter is known to located in the right atrium between two anatomical barriers. Recent electrophysiologic studies have defined the tricuspid annulus as the anterior barrier, and the terminal crest and its continuation as the eustachian ridge as the posterior barrier. Construction of a bidirectional block to conduction between these two barriers by means of lesions created with radiofrequency current have been shown to be effective in ablating the flutter. We now find that surgical creation of such a block to conduction between the barriers by a simple modification of the atrial incision line is equally effective. In a 6-year-old boy, who was admitted to our hospital for closure of an atrial septal defect and treatment of sustained atrial flutter, the atriotomy was performed perpendicular to the terminal groove and extended towards the tricuspid annulus, placing some crythermal lesions between the end of the incision and the annuals. The special defect was closed using a Dacron patch. The child was free of arrhythmia both during the postoperative stay and over the initial three months of follow-up. We conclude that this simple modification of the atrial incision line provides cure of atrial flutter in children who require atriotomy for repair of congential cardiac anomalies. It may also be beneficial in preventing ‘incisional’ reentrant tachycardia.

Keywords

Atrial flutteratrial septal defectsurgical ablation
Type
Brief Reports
Information
Cardiology in the Young , Volume 9 , Issue 2 , March 1999 , pp. 197 - 199
Copyright
Copyright © Cambridge University Press 1999

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References

1.Lewis, T, Drary, AN, Lliescu, CC. A demonstration of circus movement in clinical flutter of the auricles. Heart 1921; 8: 341–349Google Scholar
2.Boyden, PA, Frame, LH, Hoffman, BE. Activation mapping of reentry around an anatomic barrier in the canine atrium: observation during entrainment and termination. Circulation. 1989; 79: 406–416CrossRefGoogle ScholarPubMed
3.Olgin, JE, Kalman, JM, Fitzpatrick, AP, Lesh, MD. Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter: activation and entrainment mapping guided by intracardic echocardiography. Circulation 1995; 92: 1839–1848CrossRefGoogle Scholar
4.Kalman, JM, Olgin, JE, Saxon, LA, Fisher, WG, Lee, RJ, Lesh, MD. Activation and entrainment mapping defines the tricuspid annulas as the anterior barrier in typical atrial flutter. Circulation 1996; 94: 398–406CrossRefGoogle Scholar
5.Nakagawa, H, Lazzara, R, Khastgir, T et al. . Role of the tricuspid annulus and the eustachian valve/ridge on atrial flutter. Relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablation success. Circulation 1996; 94: 407–424Google ScholarPubMed
6.Klein, GJ, Guiraudon, GM, Sharma, AD, Milstein, S. Demonstration of macroreentry and feasibility of operative therapy in common type atrial flutter. Am J Cardiol 1986; 57: 587–591CrossRefGoogle Scholar
7.Cauchemez, B, Haissaguerre, M, Fischer, B, Thomas, O, Clemety, J, Coumel, P. Electrophysiological effects of catheter ablation of inferior vena cava-tricuspid annulus isthmus in common atrial flutter. Circulation 1996; 93: 284–294CrossRefGoogle ScholarPubMed
8.Chen, SA, Chiang, CE, WU, TJ et al. , Radiofrequency catheter ablation of common atrial flutter: comparision of electrophysiologically guided focal ablation technique and linear ablation technique. J Am Coll Cardiol 1996; 27: 860–868Google Scholar
9.Kalman, JM, Van Hare, GF, Olgin, JE, Saxon, LA, Stark, SI, Lesh, MD. Ablation of ‘incisional’ reentrant atrial tachycardia commplicating surgery for congential heart disease. use of entrainment to define a critical isthmus of conduction. Circulation 1996; 93: 502–512CrossRefGoogle Scholar
10.Gandhi, SK, Bromberg, BL, Schuessler, RB, Turken, BJ, Boineau, JP, Cox, JL, Huddleston, CB. Characterization and surgical ablation of atrial flutter after the classic Fontan repair. Ann Thrac Surg 1996; 61: 1666–1679CrossRefGoogle ScholarPubMed