Peculiarities of surgical treatment of atrial macro reentry tachyarrhythmia in elderly patients with implanted pacemaker

Abstract

Atrial macro reentry tachycardias are the most common tachyarrhythmias in the structure of cardiac arrhythmias in the elderly. Catheter ablations are the gold standard for the treatment of atrial macro reentry arrhythmias, but in the elderly group, the risks of complex ablations often outweigh the benefits. Aim: to determine the optimal volume of catheter ablation in atrial tachyarrhythmia using an implanted pacemaker in elderly patients. Materials and methods. The work is based on a retrospective analysis of the results of surgical treatment of (n = 45) elderly patients (75–90 years) with atrial macro reentry tachycardia, who were previously identified as an artificial pacemaker at the National M. Amosov Institute of Cardiovascular Surgery Affiliated to National Academy of Medical Sciences of Ukraine. Patients were divided into 3 groups depending on the response of the reentry tachycardia to electrical pacing (assessed by the difference between postpacing interval (PPI) and tachycardia cycle lens (CL): group І – PPI-CL 20–40 ms; group ІІ – PPI–CL 20–40 ms; group ІІІ – PPI-CL 60 ms and more. Results. In the group I (n = 20) in 100 % of the patients isthmus-dependent reentry tachyarrhythmia was diagnosed and cava-tricuspid isthmus was ablated. In the group ІІ (n = 12) 4 (33 %) patients were diagnosed with reentry tachycardia around the right pulmonary veins, in 8 (67 %) patients – reentrant tachycardia around the mitral valve. In the group ІІІ (n = 13) in 8 (62 %) patients macro reentry around the mitral valve was found, in 3 (23 %) – reentry around the left pulmonary veins, in another 2 (15 %) of the patients – reentry of the left atrial roof. Conclusions. Non-invasive electrophysiological study with pacemaker can be an effective way to study atrial macro reentry tachyarrhythmias. Electrophysiological PPI-SI criteria less than 20 ms can be used as an additional diagnostic criterion for the selection of patients for surgical treatment. Catheter ablation is recommended for elderly patients when the reentry circle is located in the right atrium.