title: Transcatheter radiofrequency ablation of atrial fibrillation in patients with mitral valve prostheses and enlarged atria: safety, feasibility, and efficacy.
abstract: OBJECTIVE
  Few data have been published on transcatheter ablation of atrial fibrillation (AF) in patients with mitral valve prostheses. Thus, we sought to report our experience.
  
  
  BACKGROUND
  Ablation is an effective treatment for AF. Patients with prosthetic mitral valves represent a special group because of an increased risk from the ablation procedure due to the possibility of damage to the prosthetic valve.
  
  
  METHODS
  Between July 2001 and July 2003, 26 patients with mitral valve prostheses (MVP) underwent circumferential pulmonary vein ablation for AF. A matched group of 52 ablated patients without MVP acted as control subjects. After a blanking period of three months, a follow-up of 12 months was considered for MVP patients and controls. Holter recordings were performed in all subjects at 3, 6, and 12 months.
  
  
  RESULTS
  Radiation exposure was higher in the MVP group, with fluoroscopy times of 35.3 +/- 21 min versus 20.9 +/- 15 min in controls. At the end of follow-up, 73% of MVP patients were in sinus rhythm, compared with 75% of controls. Atrial tachycardia occurred in six (23%) MVP patients, requiring repeat ablation in three, and one (2%) control subject, which settled without treatment. One transient ischemic attack and one femoral pseudoaneurysm occurred in the MVP group. No complications occurred in the control group.
  
  
  CONCLUSIONS
  Ablation of AF in patients with MVP is feasible, with outcomes similar to those of standard patients. Complications were higher among MVP patients with a greater radiation exposure and a higher incidence of post-ablation atrial tachycardia.
authors.affiliation: Division of Cardiac Pacing and Arrhythmias, San Raffaele Hospital, Milan, Italy.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Lang
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Santinelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Augello
authors.forename: Amedeo
authors.initials: A
authors.lastname: Ferro
authors.forename: Filippo
authors.initials: F
authors.lastname: Gugliotta
authors.forename: Simone
authors.initials: S
authors.lastname: Gulletta
authors.forename: Gabriele
authors.initials: G
authors.lastname: Vicedomini
authors.forename: Cézar
authors.initials: C
authors.lastname: Mesas
authors.forename: Gabriele
authors.initials: G
authors.lastname: Paglino
authors.forename: Simone
authors.initials: S
authors.lastname: Sala
authors.forename: Nicoleta
authors.initials: N
authors.lastname: Sora
authors.forename: Patrizio
authors.initials: P
authors.lastname: Mazzone
authors.forename: Francesco
authors.initials: F
authors.lastname: Manguso
authors.forename: Carlo
authors.initials: C
authors.lastname: Pappone
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012008:Recurrence; D013612:Tachycardia, Ectopic Atrial / Q000209:etiology / Q000401:mortality; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents