Rhythm Outcome Predictors after Concomitant Ablation during Mitral Valve Surgery

Q: What are the key findings of this study?

Concomitant surgical ablation during mitral valve surgery achieved 1-year freedom from AF in 62.9% of patients, predicted by sinus rhythm at discharge (OR 2.604, p<0.001) and paroxysmal AF.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation and mitral valve disease (n=496). Intervention: Concomitant surgical ablation during mitral valve surgery (radiofrequency or cryoablation). Primary outcome: Freedom from atrial fibrillation at 1-year follow-up (OR 2.604, 95% CI 1.676-4.048, p=<0.001).

Q: What does this research mean for the field?

Concomitant surgical ablation during mitral valve surgery achieves one-year freedom from atrial fibrillation in the majority of patients, with sinus rhythm at discharge and paroxysmal atrial fibrillation serving as significant positive predictors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate rhythm outcomes and identify independent predictors of freedom from atrial fibrillation at 1-year follow-up in patients undergoing concomitant surgical ablation during mitral valve surgery.

Ilia Bazhanov; P. Stolfa; J. Petersen; Hermann C. Reichenspurner; S. Pecha

doi:10.1055/s-0043-1761805

January 1, 2023The Thoracic and Cardiovascular Surgeon

Rhythm Outcome Predictors after Concomitant Ablation during Mitral Valve Surgery

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Key result

Sinus rhythm at discharge is linked to ~2.6-fold higher odds of 1-year freedom from AF.

OR 2.604
95% CI 1.676-4.048
P<0.001
n=496

Why the study?

Mitral valve disease is strongly associated with AF and concomitant ablation is an established procedure during cardiac surgery, prompting an evaluation of rhythm outcomes and predictors of freedom from AF during mitral valve surgery.

What are the 1-year rhythm outcomes and predictors of freedom from atrial fibrillation in patients undergoing concomitant surgical ablation during mitral valve surgery?

Key Points

To evaluate rhythm outcomes and identify independent predictors of freedom from atrial fibrillation at 1-year follow-up in patients undergoing concomitant surgical ablation during mitral valve surgery.
Retrospective analysis of 496 patients undergoing mitral valve surgery and concomitant ablation between 2003 and 2020, including 188 (37.9%) with paroxysmal and 308 (62.1%) with persistent or longstanding-persistent atrial fibrillation.
Ablation was performed via radiofrequency (n = 389, 78.4%) or cryoablation (n = 107, 21.6%), using pulmonary vein isolation (13.5%), complete left atrial lesion sets (62.9%), or biatrial ablation (23.6%).
Rhythm status was assessed at 12 months postoperatively using 24-hour Holter electrocardiography or event recorder interrogation.
Overall freedom from atrial fibrillation at 1 year was achieved in 312 of 496 patients (62.9%), with no ablation-related complications reported.
One-year rhythm success was significantly higher in paroxysmal versus persistent or longstanding-persistent atrial fibrillation (73.9% vs. 56.2%, p < 0.001), and with cryoablation compared to radiofrequency ablation (71.0% vs. 60.7%, p = 0.049).
Multivariable logistic regression identified sinus rhythm at hospital discharge (odds ratio: 2.604, 95% CI: 1.676–4.048, p < 0.001) and paroxysmal atrial fibrillation (odds ratio: 2.031, 95% CI: 1.323–3.120, p = 0.001) as significant independent predictors of 1-year freedom from atrial fibrillation.

Study Design

Type

Cohort (n=496)

Structured PICO

What are the 1-year rhythm outcomes and predictors of freedom from atrial fibrillation in patients undergoing concomitant surgical ablation during mitral valve surgery?

P

Population

496 patients (mean age 74.83 years, 55.8% male) with paroxysmal (37.9%) or persistent/longstanding-persistent (62.1%) AF undergoing mitral valve surgery and concomitant surgical ablation, followed for 1 year.

E

Exposure

Concomitant surgical ablation during mitral valve surgery using radiofrequency ablation (78.4%) or cryoablation (21.6%), with lesion sets limited to pulmonary vein isolation (13.5%), complete left atrial lesion set (62.9%), or biatrial ablation (23.6%).

O

Outcome

Freedom from atrial fibrillation at 12 months postoperatively, evaluated by 24-hour Holter ECG or event recorder interrogation.hard clinical

Main Result

Odds Ratio: 2.604 (95% CI 1.676–4.048)

p-value: p=<0.001

Concomitant surgical ablation during mitral valve surgery safely restores sinus rhythm at 1 year in nearly two-thirds of patients, with paroxysmal AF, sinus rhythm at discharge, and cryoablation associated with superior rhythm outcomes.

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Implication

Supports concomitant ablation in mitral valve surgery with AF; leaves open confirmation of predictors via randomized trials.

Abstract

All articles of this category Background: Mitral valve disease is strongly associated with the development of atrial fibrillation (AF). Concomitant ablation is an established procedure in patients with AF undergoing cardiac surgery. Therefore, we analyzed rhythm outcome and predictors of freedom from AF in patients undergoing concomitant surgical ablation during mitral valve surgery. Method: A total of 496 patients who underwent mitral valve surgery and concomitant surgical ablation between 2003 and 2020 and had a 1-year follow-up were retrospectively analyzed. A total of 188 (37.9%) patients had paroxysmal and 308 (62.1%) persistent/longstanding-persistent AF. Radiofrequency ablation was performed in 389 (78.4%) patients and cryoablation in 107 patients (21.6%). The lesions were either limited to a pulmonary vein isolation ( n = 67, 13.5%), a complete left atrial lesion set ( n = 312, 62.9%), or biatrial ablation ( n = 117, 23.6%). Follow-up rhythm evaluations were based on either 24 hour-Holter ECG or event recorder interrogation at 12 months postoperatively. Results: Mean patients age was 74.83 ± 11.6, 55.8% were male. No ablation-related complications occurred in any of the patients. Overall, at 1-year follow-up freedom from AF was achieved in 312 (62.9%) patients, showing significantly better results in patients with paroxysmal AF compared with those with persistent/longstanding-persistent AF (73.9 vs. 56.2%; p < 0.001). Logistic regression analysis revealed sinus rhythm at discharge (odds ratio: 2.604, 95% CI: 1.676–4.048, p < 0.001) and paroxysmal AF (odds ratio: 2.031, 95% CI: 1.323–3.120, p = 0.001) as statistically significant predictors for freedom from AF. Regarding energy sources, those receiving cryoablation showed significantly higher rates of freedom from AF compared with patients receiving bipolar ablation (cryoablation: 71.0% vs. radiofrequency ablation: 60.7%, p = 0.049). Conclusion: Concomitant ablation during mitral valve surgery is a safe and effective procedure for the treatment of AF. Freedom from AF was achieved in 62.9% of the patient. Sinus rhythm at discharge and paroxysmal AF were statistically significant predictors for freedom from AF. Publication History Article published online: 28 January 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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Cite This Study

Bazhanov et al. (2023) conducted a cohort in Atrial fibrillation and mitral valve disease (n=496). Concomitant surgical ablation during mitral valve surgery (radiofrequency or cryoablation) was evaluated on Freedom from atrial fibrillation at 1-year follow-up (OR 2.604, 95% CI 1.676-4.048, p=<0.001). Concomitant surgical ablation during mitral valve surgery achieved 1-year freedom from AF in 62.9% of patients, predicted by sinus rhythm at discharge (OR 2.604, p<0.001) and paroxysmal AF.

synapsesocial.com/papers/6aed4cbbe64c659ae8789523 https://doi.org/10.1055/s-0043-1761805

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Rhythm Outcome Predictors after Concomitant Ablation during Mitral Valve Surgery

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Rhythm Outcome Predictors after Concomitant Ablation during Mitral Valve Surgery

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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