Catheter ablation of atrial tachycardias after mitral valve surgery achieved 95% acute success and 0% pooled major complications, but long-term sinus rhythm maintenance was only 47%.
Meta-Analysis (n=227)
Is catheter ablation safe and effective for maintaining sinus rhythm in patients with atrial tachycardias after mitral valve surgery?
Catheter ablation for atrial tachycardias after mitral valve surgery is safe and acutely effective, but long-term efficacy declines to 47% due to progressive atrial fibrillation recurrence.
INTRODUCTION: Data regarding catheter ablation (CA) of atrial tachycardias (ATs) occurring after mitral valve surgery (MVS) are scarce. The aim of this study was to assess the safety and efficacy of CA of ATs in this surgical population through a systematic review of the literature and meta-analysis. METHODS: A systematic search on PubMed/MEDLINE, EMBASE, and Web of Science was performed considering patients undergoing CA for ATs occurring after MVS. Periprocedural thromboembolic and hemorrhagic complications were assessed. The acute success and maintenance of sinus rhythm (SR) at a mid (<24 months) and long-term follow-up (FU) after CA were investigated along with the burden of arrhythmic recurrence at FU. RESULTS: Fourteen studies for a total of 227 patients were considered. Three-dimensional (3D) mapping systems were used in all studies. Only two major bleedings were recorded with a pooled estimate of periprocedural major complications of 0%. The acute success after CA was 95% with a clear improvement over time. Although maintenance of SR was 71% at a midterm FU, long-term efficacy was as low as 47% due to an increased burden of atrial fibrillation (AF) recurrence despite multiple procedures/patient. CONCLUSION: In this meta-analysis, CA of postsurgical ATs after MVS proved safe and effective but with still a significant burden of AF recurrence at more than 24 months of FU due to a progressive atrial substrate deterioration. The improvement of procedural success over time might suggest a learning curve in optimizing the use of 3D mapping systems.
Marazzato et al. (Sat,) conducted a meta-analysis in Atrial tachycardias after mitral valve surgery (n=227). Catheter ablation was evaluated on Acute success, maintenance of sinus rhythm at mid and long-term follow-up, and periprocedural complications. Catheter ablation of atrial tachycardias after mitral valve surgery achieved 95% acute success and 0% pooled major complications, but long-term sinus rhythm maintenance was only 47%.