Key result
Concomitant ablation during valve replacement is linked to ~52% lower mortality in AF patients >=70.
Why the study?
Concomitant bipolar radiofrequency ablation and valve replacement in elderly patients with AF remains controversial.
Does concomitant bipolar radiofrequency ablation improve long-term survival and reduce stroke events in patients aged ≥ 70 years with atrial fibrillation undergoing valve replacement?
Cohort (n=68)
No
Does concomitant bipolar radiofrequency ablation improve long-term survival and reduce stroke events in patients aged ≥ 70 years with atrial fibrillation undergoing valve replacement?
Hazard Ratio: 0.479 (95% CI 0.235–0.974)
p-value: p=0.042
In patients aged ≥70 years undergoing biological valve replacement, concomitant bipolar radiofrequency ablation for atrial fibrillation is safe and associated with improved long-term survival and reduced stroke risk.
May support concomitant ablation in elderly AF patients undergoing valve surgery; leaves open confirmation in randomized trials.
Background: Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. We aim to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF).Methods: This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-center between January 2006 and March 2015. Early postoperative results and long-term clinical outcomes were compared after propensity score matching.Results: 34 pairs of patients (73.94±2,64 years old, 34 in the AF ablated group and 34 in the AF untreated group) were enrolled in the propensity score matching analysis. No significant differences between the two matched groups were found about surgical mortality (5.88% vs. 2.94%, P=0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival (P=0.009) in the AF ablated group. Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF ablated group (P=0.025, Gray’s test). Patients in the AF ablated group had a reduced incidence of stroke events compared with patients in the AF untreated group (P=0.009, Gray’s test). Freedom from AF after 5 years was 58.0% in the AF ablated group, compared with 3.0% in the AF untreated group.Conclusions: The addition of bipolar radiofrequency ablation is a feasible and safe procedure even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke events compared with valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF presenting for cardiac surgery.
No takes yet. Share an insight, caveat, or question.
Lin et al. (2020) conducted a cohort in Atrial fibrillation and valve disease (n=68). Bipolar radiofrequency ablation concomitant with valve replacement vs. Valve replacement alone was evaluated on Overall survival (all-cause death) (HR 0.479, 95% CI 0.235-0.974, p=0.042). Concomitant bipolar radiofrequency ablation during valve replacement significantly improved overall survival (HR 0.479) compared to valve replacement alone in patients aged 70 years and older with atrial fibrillation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: