Key result
Extended PVAI plus non-PV trigger elimination improved 12-month arrhythmia-free survival compared to standard PVAI alone (60.9% vs 15.6%, P<0.001) in patients with mechanical mitral valves.
Why the study?
Does extended PVAI plus non-PV trigger elimination improve arrhythmia-free survival compared to standard PVAI alone in patients with atrial fibrillation and a mechanical mitral valve?
Cohort (n=109)
Does extended PVAI plus non-PV trigger elimination improve arrhythmia-free survival compared to standard PVAI alone in patients with atrial fibrillation and a mechanical mitral valve?
Absolute Event Rate: 60.9% vs 15.6%
p-value: p=<0.001
In patients with AF and a mechanical mitral valve, an ablation strategy of extended PVAI plus non-PV trigger elimination significantly improves long-term arrhythmia-free survival compared to standard PVAI alone.
May support extended ablation strategies in this population; leaves open need for randomized confirmation before practice change.
INTRODUCTION: It is unclear whether extended pulmonary vein antrum isolation (PVAI) plus nonpulmonary vein (non-PV) trigger elimination prevents more arrhythmia recurrence than PVAI alone in patients with mechanical mitral valve (MMV) undergoing AF ablation. This study compared the efficacy and long-term outcome of 2 ablation strategies--PVAI alone versus extended PVAI plus non-PV trigger elimination--for the treatment of AF in patients with MMV. METHODS AND RESULTS: One hundred and nine consecutive AF patients with MMV were divided into 2 groups: standard PVAI was performed in group 1 (N = 45); in group 2 (N = 64) PVAI was extended to the LA posterior wall, LA septum, and CS; and all non-PV triggers were eliminated. Patients were followed up for 3 years. At the 12th month, 7 (15.6%) patients in group 1, and 39 (60.9%) patients in group 2 were arrhythmia free (log-rank P < 0.001). Four patients (8.9%; 3 cases of AT and 1 case of AF) from group 1, and 12 patients (18.8%; 9 cases of AT, and 3 cases of AFL) from group 2 experienced very late recurrence. At 36 ± 7 months follow-up, the cumulative recurrence after a single procedure was 42/45 (93.3%) in group 1, and 37/64 (57.8%) in group 2 (log-rank P < 0.001). CONCLUSION: Compared with the standard PVAI alone, a strategy including extended PVAI and non-PV trigger elimination is associated with a higher 12-month and long-term arrhythmia-free survival in patients with MMV undergoing AF ablation. Very late recurrence may occur years after the initial procedure with focal AT as the most common type of recurrent arrhythmia.
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Bai et al. (2014) conducted a cohort in Atrial Fibrillation with Mechanical Mitral Valve (n=109). Extended PVAI plus non-PV trigger elimination vs. Standard PVAI alone was evaluated on Arrhythmia-free survival at 12 months (p=<0.001). Extended PVAI plus non-PV trigger elimination improved 12-month arrhythmia-free survival compared to standard PVAI alone (60.9% vs 15.6%, P<0.001) in patients with mechanical mitral valves.
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