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Atrial Incision Affects the Incidence of Atrial Tachycardia After Mitral Valve Surgery Peter Lukac, MD, Vibeke E. Hjortdal, MD, PhD, Anders K. Pedersen, MD, DMSc, Peter T. Mortensen, MD, Henrik K. Jensen, MD, PhD, Peter S. Hansen, MD, PhD The Annals of Thoracic Surgery Volume 81, Issue 2, Pages 509-513 (February 2006) DOI: 10.1016/j.athoracsur.2005.07.083 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The superior transseptal approach. Incisions in the free wall of the right atrium (RA) and in the interatrial septum (IAS) are connected and prolonged to the superior portion of the left atrium (LA). (IVC = inferior vena cava; SVC = superior vena cava; PV = pulmonary vein.) The Annals of Thoracic Surgery 2006 81, 509-513DOI: (10.1016/j.athoracsur.2005.07.083) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 An example of atrial tachycardia. The regularity of the atrial rhythm is best appreciated in lead V1, where regular monomorphic negative P waves (their beginning is marked with the calipers), separated by a slightly descending plateau, can be appreciated. The cycle length is 220 ms. In this case, the differential diagnosis against atrial fibrillation might be difficult, if the ventricular rate was not regular. However, ventricular activation may not always be regular during atrial tachycardia. The Annals of Thoracic Surgery 2006 81, 509-513DOI: (10.1016/j.athoracsur.2005.07.083) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Kaplan-Meier curves showing cumulative event rates of atrial tachycardia for both groups. (Group A = superior transseptal approach; Group B = left atrial approach.) The Annals of Thoracic Surgery 2006 81, 509-513DOI: (10.1016/j.athoracsur.2005.07.083) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Kaplan-Meier curves showing cumulative event rates of atrial fibrillation in both groups. (Group A = superior transseptal approach; Group B = left atrial approach.) The Annals of Thoracic Surgery 2006 81, 509-513DOI: (10.1016/j.athoracsur.2005.07.083) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Kaplan-Meier curves showing cumulative event rates of atrial tachycardia and atrial fibrillation after the superior transseptal approach. The Annals of Thoracic Surgery 2006 81, 509-513DOI: (10.1016/j.athoracsur.2005.07.083) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions