Surgical Treatment of Atrial Fibrillation in Rheumatic Mitral Valve Disease: A Literature Review

Atrial fibrillation (AF) often develops in the context of rheumatic mitral valve diseases, significantly impacting patient prognosis. The importance of not only addressing valve pathology but also simultaneously treating the arrhythmia to reduce the risk of thromboembolic complications is crucial. This literature review explores modern surgical approaches for the treatment of AF in the context of rheumatic mitral valve diseases. Methods: This review critically examines the latest advancements in surgical techniques for treating AF in patients with mitral valve pathology, focusing on the innovative cryoablation technique combined with left atrial appendage clipping on open-heart surgery, first implemented in Kazakhstan at the Research Institute of Cardiology and Internal Medicine and currently practiced at the City Cardiological Center. Additional surgical interventions discussed include mitral valve repair or replacement, as well as adjunctive AF ablation methods such as the Cox-Maze procedure and cryoablation using the "ArtiCure" system. Results: This review presents a comparative analysis of surgical approaches, focusing on outcomes such as stroke risk reduction, mortality, and long-term rhythm stability. Cryoablation with left atrial appendage clipping has shown promising results in improving rhythm control and reducing the incidence of thromboembolic events. Mitral valve repair or replacement combined with AF ablation procedures such as Cox-Maze has also been associated with favorable long-term outcomes. Discussion: The review discusses the clinical criteria for selecting candidates for these surgical interventions, postoperative management strategies, and the impact of these treatments on the patient's quality of life. The integration of recent research findings with clinical practice underscores the effectiveness of combining valve surgery with AF ablation for improving long-term patient outcomes. The article also highlights the importance of addressing the underlying mitral valve pathology in managing AF.