title: Hybrid therapy of radiofrequency catheter ablation and percutaneous transvenous mitral commissurotomy in patients with atrial fibrillation and mitral stenosis.
abstract: BACKGROUND
  The rhythm control of atrial fibrillation (AF) associated with mitral stenosis (MS) is often difficult using antiarrhythmic drugs (AADs), even after a percutaneous transvenous mitral commissurotomy (PTMC). Few studies have examined the efficacy and safety of simultaneously performing radiofrequency catheter ablation (RFCA) and a PTMC in patients with MS and AF.
  
  
  METHODS
  Twenty consecutive patients with drug-resistant AF and rheumatic MS underwent RFCA combined with a PTMC (n = 10; persistent AF-8, long-lasting [>1 year] persistent AF-2; RFCA group) or transthoracic direct cardioversion (DC) following a PTMC (n = 10; persistent AF-7, long-lasting persistent AF-3; DC group). In all patients, the mitral valve morphology was amenable to a PTMC, and more than 2 AADs had been ineffective in maintaining sinus rhythm (SR). In the RFCA group, a segmental pulmonary vein isolation (PVI) was performed in the initial 5 patients, and an extensive PVI was performed in the remaining 5.
  
  
  RESULTS
  During a mean follow-up period of 4.0 +/- 2.7 years, 8 patients (80%) in the RFCA group were maintained in SR, as compared to 1 (10%) in the DC group (hazard ratio, 0.16; 95% confidence interval, 0.03 to 0.75; P = 0.008 by the log-rank test). The prevalence of the concomitant use of class I and/or class III AADs was comparable between the 2 groups (P = 0.70). No complications occurred during the procedure or follow-up period in either group.
  
  
  CONCLUSIONS
  The hybrid therapy using RFCA and a PTMC was safe and feasible, and significantly improved the AF free survival rate compared to DC following a PTMC.
authors.affiliation: Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Machino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tada
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Shigeto
authors.initials: S
authors.lastname: Naito
authors.forename: Hiro
authors.initials: H
authors.lastname: Yamasaki
authors.forename: Takanori
authors.initials: T
authors.lastname: Arimoto
authors.forename: Miyako
authors.initials: M
authors.lastname: Igarashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuroki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Seo
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Watanabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hoshizaki
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
authors.forename: Koichi
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome