Surgical treatment of postoperative atrial reentry tachycardia

Late postoperative reentry tachycardia is a major source of morbidity and mortality after intracardiac repair of congenital heart disease. The incidence is greatest after the Fontan operation, but is significant after repair of other defects. Although medical, pacing, and ablation therapy each play a role in treating these tachyarrhythmias, none are completely effective. In addition, many of these patients require additional surgical procedures to improve hemodynamic abnormalities. We have combined intracardiac electrophysiologic studies with detailed mapping and a direct surgical approach using cryoablation to divide reentry circuits. Permanent atrial pacing is an important part of each surgical procedure. This extensive right atrial maze procedure has been highly effective in eliminating atrial reentry tachycardia.