{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T01:49:46Z","timestamp":1747187386258,"version":"3.40.5"},"reference-count":15,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T00:00:00Z","timestamp":1619136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Advancements in minimally invasive surgical ablation (MISA) have focused on improving pulmonary vein isolation. Additional ablation targets have been developed (such as posterior wall isolation). The mid\u2010 and long\u2010term effects of current techniques (including electrophysiologic findings and recurrent arrhythmia mechanisms) have not previously been reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty eight patients with recurrent atrial arrhythmias after bipolar clamp ablation of the pulmonary vein antrum, ganglionated plexi, posterior wall isolation (roof and floor lines to create a posterior box), and ligament of Marshall ligation\/cauterization and left atrial appendage clipping underwent follow up electrophysiology study including left atrial mapping an average of 2.3 years postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Atrial fibrillation was the most common recurrent arrhythmia (<jats:italic>n<\/jats:italic>\u00a0=\u00a018) followed by micro\u2010reentrant atrial tachycardia (<jats:italic>n<\/jats:italic>\u00a0=\u00a05), macro\u2010reentry left atrial flutter (<jats:italic>n<\/jats:italic>\u00a0=\u00a03), and typical cavo\u2010tricuspid isthmus atrial flutter (<jats:italic>n<\/jats:italic>\u00a0=\u00a02). Eighty six of 112 (77%) PVs mapped were electrically isolated, 16 (57%) patients had all four pulmonary veins (PVs) isolated. The posterior wall (PW) was completely isolated in only four (14%) patients, seven (25%) patients had normal PW voltage, while 17 (61%) patients had abnormal delayed or fractionated electrograms in the posterior wall (incomplete isolation). Abnormal PW electrograms were more frequently found in patients with complex recurrent left atrial arrhythmia (micro\u2010reentry or left atrial macro\u2010reentry flutter).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>With current surgical techniques PV isolation has improved, but PW isolation remains challenging. Incomplete PW isolation may produce arrhythmogenic substrate.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.14242","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T13:35:40Z","timestamp":1617802540000},"page":"1054-1061","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spectrum of arrhythmogenic substrate post minimally invasive maze surgery in patients with recurrent"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0046-3473","authenticated-orcid":false,"given":"Timothy R.","family":"Larsen","sequence":"first","affiliation":[{"name":"Department of Cardiology Division of Electrophysiology Rush University Medical Center  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayanthi N.","family":"Koneru","sequence":"additional","affiliation":[{"name":"Division of Cardiology Pauley Heart Center Virginia Commonwealth University Medical Center  Richmond Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santosh K.","family":"Padala","sequence":"additional","affiliation":[{"name":"Division of Cardiology Pauley Heart Center Virginia Commonwealth University Medical Center  Richmond Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vigneshwar","family":"Kasirajan","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery Pauley Heart Center Virginia Commonwealth University Medical Center  Richmond Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8527-569X","authenticated-orcid":false,"given":"Kenneth A.","family":"Ellenbogen","sequence":"additional","affiliation":[{"name":"Division of Cardiology Pauley Heart Center Virginia Commonwealth University Medical Center  Richmond Virginia 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