Catheter ablation of atrial fibrillation in patients with valvular heart disease: long-term follow-up results.
AF Ablation in Patients With Valvular Heart Disease.


BACKGROUND
The purpose of this study is to evaluate the efficacy of atrial fibrillation (AF) ablation in patients with moderate valvular heart disease (VHD).


METHODS
In total, 534 consecutive patients who underwent AF ablation were enrolled. Patients with a history of valve surgery or other structural heart disease were excluded. Patients with clinically moderate VHD (group-1, n = 45) were compared with those without VHD (control group-2, n = 436). Ipsilateral pulmonary vein antrum isolation (PVAI) was performed with a double Lasso technique in all the patients. Left atrial (LA) linear ablation was undertaken in persistent AF patients, if AF was inducible after PVAI.


RESULTS
Patients in group-1 were significantly older and had a larger LA. PVAI was successfully achieved in all the patients. Patients in group-1 received LA linear ablation more frequently during the index procedure. After a median of 26 months from the index procedure, the freedom from AF was significantly lower in group-1 than group-2 off antiarrhythmic drugs (AADs) (47% vs 69%, P = 0.002). Although there were more number of total procedures in group-1 than group-2, the freedom from AF was lower at median 24 months after the last procedure (78% vs 87%, P = 0.038). There was no significant difference in the freedom from AF on AADs (91% vs 95%, P = 0.356) or complication rate between the 2 groups. Atrial tachycardia following the index procedure was observed more frequently in group-1 (P = 0.001).


CONCLUSIONS
The patients with VHD undergoing AF ablation are less likely to remain in sinus rhythm at long term without AADs than those without VHD.
Miyazaki
Shinsuke
S
Cardiovascular Center, Yokosuka Kyosai Hospital, Yonegahamadori, Yokosuka-shi, Kanagawa-ken, Japan. mshinsuke@k3.dion.ne.jp
Kuwahara
Taishi
T
Kobori
Atsushi
A
Takahashi
Yoshihide
Y
Takei
Asumi
A
Sato
Akira
A
Isobe
Mitsuaki
M
Takahashi
Atsushi
A
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome