Key result
In patients undergoing catheter ablation for atrial fibrillation, prior mitral valve surgery resulted in a 31.7% freedom from atrial arrhythmias after a single procedure compared to 40.0% in matched controls, though 90.0% achieved sinus rhythm after repeat procedures.
Why the study?
Atrial fibrillation occurs frequently after mitral valve surgery, but the efficacy and long-term clinical outcomes of a first catheter ablation in this population needed evaluation.
Does catheter ablation for atrial fibrillation provide comparable long-term freedom from atrial arrhythmias in patients with a history of mitral valve surgery compared to those without prior mitral valve surgery?
Cohort (n=120)
Yes
Does catheter ablation for atrial fibrillation provide comparable long-term freedom from atrial arrhythmias in patients with a history of mitral valve surgery compared to those without prior mitral valve surgery?
Absolute Event Rate: 31.7% vs 40%
p-value: p=0.34
Catheter ablation for atrial fibrillation in patients with prior mitral valve surgery is safe and achieves long-term sinus rhythm maintenance comparable to patients without prior valve surgery, though repeat procedures and antiarrhythmic drugs are frequently required.
Should not yet change practice; leaves open the role of ablation for post-MV AF pending prospective confirmation.
Aims Atrial fibrillation (AF) occurs frequently after mitral valve (MV) surgery. This study aims to evaluate the efficacy and long-term clinical outcomes after the first AF ablation in patients with prior MV surgery. Methods Sixty consecutive patients with a history of MV surgery without MAZE referred to three European centers for a first AF ablation between 2007 and 2017 (group 1) were retrospectively enrolled. They were matched (propensity score match) with 60 patients referred for AF ablation without prior MV surgery (group 2). Results After the index ablation, 19 patients (31.7%) from group 1 and 24 (40%) from group 2 had no recurrence of atrial arrhythmias (ATa) ( p = 0.3). After 62 (48–84) months of follow-up and 2 (2–2) procedures, 90.0% of group 1 and 95.0% of group 2 patients were in sinus rhythm ( p = 0.49). In group 1, 19 (31.7%) patients had mitral stenosis, and 41 (68.3%) had mitral regurgitation. Twenty-seven (45.0%) patients underwent mechanical valve replacement and 33 (55.0%) MV annuloplasty. At the final follow-up, 28 (46.7%) and 33 (55.0%) patients were off antiarrhythmic drugs ( p = 0.46). ATa recurrence was seen more commonly in patients with prior MV surgery (54 vs. 22%, respectively, p < 0.05). No major complication occurred. Conclusion Long-term freedom of atrial arrhythmias after atrial fibrillation catheter ablation is achievable and safe in patients with a history of mitral valve surgery. In AF patients without a history of mitral valve surgery, repeated procedures are needed to maintain sinus rhythm.
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Almorad et al. (2022) conducted a cohort in Atrial fibrillation (n=120). Prior mitral valve surgery vs. No prior mitral valve surgery was evaluated on Freedom from atrial arrhythmias after index ablation (p=0.34). In patients undergoing catheter ablation for atrial fibrillation, prior mitral valve surgery resulted in a 31.7% freedom from atrial arrhythmias after a single procedure compared to 40.0% in matched controls, though 90.0% achieved sinus rhythm after repeat procedures.
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