TY - JOUR
T1 - Use of intraoperative mapping to optimize surgical ablation of atrial flutter
AU - Yamauchi, Shigeo
AU - Schuessler, Richard B.
AU - Kawamoto, Tomohide
AU - Shuman, Todd A.
AU - Boineau, John P.
AU - Cox, James L.
N1 - Funding Information:
Supported by National Institutes of Health grants R01 HL33722 and R01 HL32257.
PY - 1993/8
Y1 - 1993/8
N2 - The purpose of this study was to develop a surgical treatment for atrial flutter using intraoperative activation sequence mapping to minimize the surgical procedure necessary to ablate the flutter. A canine model (n = 10) of left atrial enlargement was developed by creating a shunt from the left subclavian artery to the left superior pulmonary vein. Sustained atrial flutter was easily induced in this model. The flutter consisted of a single reentrant circuit that rotated around one or two anatomic obstacles linked by a region of functional block. Epicardial templates, consisting of 252 bipolar electrodes, were used to record activation time maps. After localization of the reentrant circuit, surgical incisions were placed to interrupt the pathways. In all 10 animals, flutter could be induced and intraoperative mapping localized the reentrant circuit. Seven circuits were in the right atrium and three were in the left atrium. The operation ablated all of the preoperative circuits. However, in 5 of the animals, flutter originating from a new circuit could be induced. Activation sequence mapping before and after operation demonstrates that there are multiple potential reentrant pathways in this canine model of atrial futter. Therefore, all potential pathways must be surgically interrupted to prevent inducibility of atrial flutter.
AB - The purpose of this study was to develop a surgical treatment for atrial flutter using intraoperative activation sequence mapping to minimize the surgical procedure necessary to ablate the flutter. A canine model (n = 10) of left atrial enlargement was developed by creating a shunt from the left subclavian artery to the left superior pulmonary vein. Sustained atrial flutter was easily induced in this model. The flutter consisted of a single reentrant circuit that rotated around one or two anatomic obstacles linked by a region of functional block. Epicardial templates, consisting of 252 bipolar electrodes, were used to record activation time maps. After localization of the reentrant circuit, surgical incisions were placed to interrupt the pathways. In all 10 animals, flutter could be induced and intraoperative mapping localized the reentrant circuit. Seven circuits were in the right atrium and three were in the left atrium. The operation ablated all of the preoperative circuits. However, in 5 of the animals, flutter originating from a new circuit could be induced. Activation sequence mapping before and after operation demonstrates that there are multiple potential reentrant pathways in this canine model of atrial futter. Therefore, all potential pathways must be surgically interrupted to prevent inducibility of atrial flutter.
UR - http://www.scopus.com/inward/record.url?scp=0027200822&partnerID=8YFLogxK
U2 - 10.1016/0003-4975(93)91172-J
DO - 10.1016/0003-4975(93)91172-J
M3 - Article
C2 - 8347018
AN - SCOPUS:0027200822
SN - 0003-4975
VL - 56
SP - 337
EP - 342
JO - The Annals of thoracic surgery
JF - The Annals of thoracic surgery
IS - 2
ER -