Key result
Endocardial pulsed-field ablation during mitral valve surgery achieved complete conduction block and maintained sinus rhythm at 12 months in 2 of 2 patients (100%) without device-related adverse events.
Why the study?
Does concomitant endocardial monopolar pulsed-field ablation safely achieve electrical isolation and maintain sinus rhythm in patients with atrial fibrillation undergoing open-heart mitral valve surgery?
Case Report (n=2)
No
Does concomitant endocardial monopolar pulsed-field ablation safely achieve electrical isolation and maintain sinus rhythm in patients with atrial fibrillation undergoing open-heart mitral valve surgery?
This initial two-patient report demonstrates the technical feasibility, acute electrophysiological competence, and 1-year rhythm success of using an endocardial monopolar pulsed-field ablation probe to perform a full biatrial Maze IV lesion set during open-heart mitral valve surgery.
Answers are grounded in this paper and cite their sources.
Pulsed-field ablation may enable Maze IV during mitral surgery; leaves open confirmation of safety and efficacy in larger trials.
Pulsed-field ablation is a new treatment option for atrial fibrillation. However, information regarding the use of this type of energy during open-heart surgery is limited. In this study, we describe the use of an endocardial pulsed-field ablation system for treating atrial fibrillation during mitral valve surgery. Two patients underwent mitral valve surgery and concomitant pulsed-field ablation using an endocardial monopolar probe. Ablation procedures were successfully performed in both patients. Electrophysiological studies confirmed the competence of all ablation lines. No device-related adverse effect was observed. After 12 months, the patients were in sinus rhythm, without documented atrial fibrillation paroxysms. The use of pulsed-field energy for atrial fibrillation treatment during open cardiac surgery demonstrated promising results in these two initial patients. However, given the preliminary nature of this report, these findings must be interpreted cautiously. Further studies with larger sample sizes are warranted.
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Махарамович et al. (2026) conducted a case report in Atrial fibrillation and mitral valve disease (n=2). Endocardial monopolar pulsed-field ablation (Biotok system) during open-heart mitral valve surgery was evaluated on Sinus rhythm without documented atrial fibrillation paroxysms at 12 months. Endocardial pulsed-field ablation during mitral valve surgery achieved complete conduction block and maintained sinus rhythm at 12 months in 2 of 2 patients (100%) without device-related adverse events.
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