Title:Advances in Catheter Ablation: Atrial Fibrillation Ablation in Patients With Mitral Mechanical Prosthetic Valve
VOLUME: 8 ISSUE: 4
Author(s):Pasquale Santangeli, Luigi DI Biase, Rong Bai, Rodney Horton, J. David Burkhardt, Javier Sanchez, Justin Price and Andrea Natale
Affiliation:Executive Medical Director of the Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Austin, Texas, 1015 East 32nd Street, Suite 516, Austin, TX 78705, USA.
Keywords:Atrial fibrillation; mitral valve replacement; radiofrequency catheter ablation
Abstract:Atrial fibrillation (AF) is common in patients with mitral valve replacement (MVR). Treatment of AF in these
subjects is challenging, as the arrhythmia is often refractory to antiarrhythmic drug therapy. Radiofrequency catheter ablation
(RFCA) is usually avoided or delayed in patients with MVR due to the higher perceived risks and difficulty of left
atrial catheter manipulation in the presence of a mechanical valve. Over the last few years, several investigators have reported
the feasibility and safety of RFCA of AF in patients with MVR. Five case-control studies have evaluated the feasibility
and safety of RFCA of AF or perimitral flutter (PMFL) in patients with MVR. Overall, a total of 178 patients with
MVR have been included (21 undergoing ablation of only PMFL), and have been compared with a matched control group
of 285 patients. Total procedural duration (weigthed mean difference [WMD] = +24.5 min, 95% confidence interval [CI]
+10.2 min to +38.8 min, P = 0.001), and fluoroscopy time (WMD = +13.5 min, 95% CI +3.7 min to +23.4 min, P =
0.007) were longer in the MVR group. After a mean follow-up of 11.5 ± 8.6 months, 64 (36%) patients in the MVR group
experienced recurrence of AF/PMFL, as compared to 73 (26%) patients in the control group, accounting for a trend toward
an increased rate of recurrences in patients with MVR (odds ratio [OR] = 1.66, 95% CI 0.99 to 2.78, P = 0.053). Periprocedural
complications occurred in 10 (5.6%) patients in the MVR group, and in 8 (2.8%) patients in the control group
(OR = 2.01, 95% CI 0.56 to 7.15, P = 0.28). In conclusion, a quantitative analysis of the available evidence supports a
trend toward a worse arrhythmia-free survival and a higher absolute rate of periprocedural complications in patients with
MVR undergoing RFCA of AF or PMFL, as compared to a matched control group without mitral valve disease. These
data would encourage the adoption of RFCA of AF in MVR patients mostly by more experienced Institutions.
