Key result
Complete bi-atrial ablation linked to ~24% greater 60-month freedom from atrial tachyarrhythmias versus simplified lesion sets.
Why the study?
The necessity of a complete bi-atrial lesion created by radiofrequency clamp and pen for nonparoxysmal AF in patients with RMVD remains unclear.
Does a complete bi-atrial lesion set created by radiofrequency clamp and pen improve freedom from atrial tachyarrhythmias compared to simplified lesion sets in patients with RMVD and nonparoxysmal AF undergoing mitral valve surgery?
Cohort (n=540)
Does a complete bi-atrial lesion set created by radiofrequency clamp and pen improve freedom from atrial tachyarrhythmias compared to simplified lesion sets in patients with RMVD and nonparoxysmal AF undergoing mitral valve surgery?
Absolute Event Rate: 65.4% vs 52.7%
p-value: p=0.012
Complete bi-atrial ablation using a radiofrequency clamp and pen during mitral valve surgery for rheumatic mitral valve disease provides superior long-term freedom from atrial tachyarrhythmias compared to simplified ablation techniques.
May support complete bi-atrial ablation in rheumatic mitral surgery; hypothesis-generating and leaves open randomized confirmation.
INTRODUCTION: The necessity of complete bi-atrial lesion created by radiofrequency clamp and pen for nonparoxysmal atrial fibrillation (AF) in patients with rheumatic mitral valve disease (RMVD) remains unclear. METHODS: From January 2014 to December 2018, patients with RMVD concomitant with nonparoxysmal AF who underwent mitral valve surgery concomitant surgical ablation were retrospectively enrolled. We divided patients into Group A (complete bi-atrial lesion set created by radiofrequency clamp and pen) and Group B (simplified lesion sets created by radiofrequency clamp alone including bi-atrial ablation with incomplete mitral isthmus line and stand-alone left atrial ablation) according to the surgical ablation lesion sets. Propensity score matching was applied to analyze freedom from atrial tachyarrhythmias between the two groups. RESULTS: Two hundred eight (38.5%) and 332 (61.5%) patients were divided into Group A and Group B, respectively. In Group B, the proportion of patients with recurrent atrial flutter in the subgroup of bi-atrial ablation with incomplete mitral isthmus line was higher than that in Group A (p = .044). After propensity score matching, there were 203 patients in each group. Better freedom from atrial tachyarrhythmias without antiarrhythmic drugs was obtained in Group A (83.1%, 79.6%, and 65.4%) than Group B (73.1%, 68.4%, and 52.7%) at 12, 36, and 60 months after operation (p = .012). CONCLUSION: The application of radiofrequency clamp and pen to create complete bi-atrial lesion set in surgical ablation for nonparoxysmal AF in RMVD was associated with superior long-term efficacy.
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Li et al. (2022) conducted a cohort in Rheumatic mitral valve disease with nonparoxysmal atrial fibrillation (n=540). Complete bi-atrial ablation (radiofrequency clamp and pen) vs. Simplified lesion sets (radiofrequency clamp alone) was evaluated on Freedom from atrial tachyarrhythmias without antiarrhythmic drugs at 60 months (p=0.012). Complete bi-atrial ablation using a radiofrequency clamp and pen improved 60-month freedom from atrial tachyarrhythmias compared to simplified lesion sets (65.4% vs 52.7%; p=0.012).
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