title: Radiofrequency ablation of atrial fibrillation in patients with mitral or aortic mechanical prosthetic valves: a feasibility, safety, and efficacy study.
abstract: BACKGROUND
  Patients with prosthetic valves have a high prevalence of atrial fibrillation (AF). We report a multicenter experience of performing pulmonary vein antral isolation (PVAI) in this challenging, high-risk cohort of patients.
  
  
  OBJECTIVE
  The purpose of this study was to assess the feasibility, safety, and efficacy of radiofrequency (RF) ablation for sinus rhythm restoration in AF patients with mitral or aortic mechanical prosthetic valves.
  
  
  METHODS
  A total of 50 patients with prosthetic valves (group I) who underwent RF ablation for AF between January 1, 2007, and April 30, 2009, were identified prospectively at four tertiary care centers. A matched group of 50 patients (group II) acted as controls.
  
  
  RESULTS
  Total procedural time (199.4 ± 49 minutes vs 166.6 ± 27.5 minutes, P <.001) and fluoroscopy time (60 ± 17 minutes vs 53.8 ± 6.8 minutes, P <.01) were prolonged, with a higher incidence of atrial flutter at 3 months in group I (18% vs 6%, P = .1) compared to group II. At 12 months, 80% of patients in the valve group were in sinus rhythm after an average of 1.3 procedures, and 82% of controls were in sinus rhythm after an average 1.2 procedures (P = .9). There was a trend toward a higher nonfatal complication rate in the valve group than in the control group (8% vs 4%, P = .1).
  
  
  CONCLUSIONS
  In patients with prosthetic valves, RF ablation for AF is feasible, safe, and efficacious, with a trend toward a higher nonfatal complication rate and an increased rate of postablation atrial flutter.
authors.affiliation: Division of Cardiovascular Medicine, Cardiovascular Research Institute, University of Kansas Medical Center and Hospital, Kansas City, Kansas, USA. dlakkireddy@mac.md
authors.forename: Dhanunjaya
authors.initials: D
authors.lastname: Lakkireddy
authors.forename: Darbhamulla
authors.initials: D
authors.lastname: Nagarajan
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Subba Reddy
authors.initials: SR
authors.lastname: Vanga
authors.forename: Srijoy
authors.initials: S
authors.lastname: Mahapatra
authors.forename: T
authors.initials: T
authors.lastname: Jared Bunch
authors.forename: John D
authors.initials: JD
authors.lastname: Day
authors.forename: David J
authors.initials: DJ
authors.lastname: Burkhardt
authors.forename: Linda
authors.initials: L
authors.lastname: Umbarger
authors.forename: Raghuveer
authors.initials: R
authors.lastname: Dendi
authors.forename: Rhea
authors.initials: R
authors.lastname: Pimentel
authors.forename: Loren
authors.initials: L
authors.lastname: Berenbom
authors.forename: Martin
authors.initials: M
authors.lastname: Emert
authors.forename: Anna
authors.initials: A
authors.lastname: Gerken
authors.forename: Sudharani
authors.initials: S
authors.lastname: Bommana
authors.forename: Wallace
authors.initials: W
authors.lastname: Ray
authors.forename: Donita
authors.initials: D
authors.lastname: Atkins
authors.forename: Caroline
authors.initials: C
authors.lastname: Murray
authors.forename: Buddhadeb
authors.initials: B
authors.lastname: Dawn
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001021:Aortic Valve; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery; D006339:Heart Rate / Q000502:physiology*; D006349:Heart Valve Diseases / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D012189:Retrospective Studies; D016896:Treatment Outcome