Radiofrequency ablation of atrial fibrillation in patients with mechanical mitral valve prostheses: Safety, feasibility, electrophysiologic findings, and outcomes

Ayman A. Hussein, Oussama M. Wazni, Serge Harb, Lee Joseph, Mohammed Chamsi-Pasha, Mandeep Bhargava, David O. Martin, Thomas Dresing, Thomas Callahan, Mohamed Kanj, Andrea Natale, Bruce D. Lindsay, Walid I. Saliba

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Objectives: The purpose of this study was to evaluate the feasibility, safety, and outcomes of radiofrequency ablation of atrial fibrillation (AF) in patients with mechanical mitral valve replacement (MVR). Background: The role of ablative therapy in patients with MVR is not yet established, with safety concerns and very few outcome data. Methods: Between January 2003 and December 2008, we followed up 81 patients with MVR undergoing first-time AF ablation (compared with 162 age- and sex-matched controls). Arrhythmia recurrences were identified by symptoms with documentation, event monitoring, Holter monitoring, and electrocardiograms. Results: All MVR and control patients underwent ablation under therapeutic international normalized ratio. No entrapment of catheters or stroke occurred. There were no differences in terms of procedure-related complications between the groups (p = NS). Patients with MVR had larger atria (p < 0.0001), lower left ventricular ejection fractions (p = 0.0001), and more concomitant atrial flutter at baseline (p < 0.0001). Over a 24-month follow-up, they had higher recurrence rates compared with controls (49.4% vs. 27.7% after a single ablation, p = 0.0006). The creation of flutter lines significantly reduced recurrences in patients with any history of atrial flutter (16.7% vs. 60.9%, p = 0.009). At last follow-up, 82.7% of MVR patients had their arrhythmia controlled (69.1% not receiving antiarrhythmic drugs). Conclusions: Radiofrequency ablation is feasible and safe for patients with MVR. It allowed restoration of sinus rhythm in a substantial proportion of patients undergoing ablation. An abnormal atrial substrate underlies recurrences in these patients. The ablation procedure needs to be further refined with a focus on extra pulmonary vein triggers and concomitant flutters to improve outcomes.

Original languageEnglish (US)
Pages (from-to)596-602
Number of pages7
JournalJournal of the American College of Cardiology
Volume58
Issue number6
DOIs
StatePublished - Aug 2 2011

Keywords

  • atrial fibrillation
  • mitral valve prostheses
  • radiofrequency ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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