Key result
Giant LA linked to ~129% greater atrial tachyarrhythmia recurrence after mitral valve surgery with ablation.
Why the study?
The study aimed to compare the efficacy of radiofrequency ablation in patients undergoing mitral valve surgery with or without giant left atria.
Does radiofrequency ablation prevent thromboembolic events and atrial tachyarrhythmia recurrence in patients with giant left atria undergoing mitral valve surgery compared to those without giant left atria?
Cohort (n=1,784)
No
Does radiofrequency ablation prevent thromboembolic events and atrial tachyarrhythmia recurrence in patients with giant left atria undergoing mitral valve surgery compared to those without giant left atria?
Concomitant radiofrequency ablation during mitral valve surgery in patients with giant left atria has a high arrhythmia recurrence rate but is equally effective at preventing thromboembolic events compared to patients with normal-sized atria.
Giant left atria associated with higher arrhythmia recurrence after ablation; leaves open net benefit of concomitant radiofrequency ablation during mitral valve surgery.
PURPOSE: We aimed to compare the efficacy of radiofrequency ablation (RFA) in patients undergoing mitral valve (MV) surgery with or without giant left atria. METHODS: This retrospective, single-center, cohort study investigated patients who underwent MV surgery and concomitant RFA from 2009 to 2019. Patients were divided into non-giant left atria (diameter ≤65 mm, n = 1543) and giant left atria (diameter >65 mm, n = 241) groups. Five-year freedom from atrial tachyarrhythmia recurrence and thromboembolic event (TE) rates were assessed with death as the competing risk factor with and without propensity-score matching. RESULTS: Patients with giant left atria had higher mortality (10.8% versus 6.2%, P = 0.008) and readmission rates for heart failure than those without (12.0% versus 6.8%, P = 0.004). Atrial tachyarrhythmia recurrence rates were higher in patients with giant left atria than in those without (49% versus 24% at 5 years, P <0.001), but the cumulative incidence of TEs before (P = 0.944) and after (P = 0.695) propensity-score matching was comparable. CONCLUSIONS: RFA effectively prevented TEs in patients with giant left atria, despite significant atrial tachyarrhythmia recurrence. Atrial tachyarrhythmia recurrence did not increase the risk of TEs. A lower success rate should be considered when deciding whether to perform surgical ablation in patients with giant left atria.
No takes yet. Share an insight, caveat, or question.
Ye et al. (2022) conducted a cohort in Atrial fibrillation in patients undergoing mitral valve surgery (n=1,784). Giant left atria (diameter >65 mm) vs. Non-giant left atria (diameter ≤65 mm) was evaluated on 5-year cumulative incidence of atrial tachyarrhythmia recurrence (SHR 2.286, 95% CI 1.816-2.877, p=<0.001). Patients with giant left atria undergoing mitral valve surgery with radiofrequency ablation had a significantly higher 5-year rate of atrial tachyarrhythmia recurrence compared to those without giant left atria (49% vs 24%, SHR 2.286).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: