title: Advances in catheter ablation: atrial fibrillation ablation in patients with mitral mechanical prosthetic valve.
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 (weighted 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.
authors.affiliation: Texas Cardiac Arrhythmia Institute - St. David's Medical Center, Austin, TX 78705, USA.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: Rodney
authors.initials: R
authors.lastname: Horton
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: Javier
authors.initials: J
authors.lastname: Sanchez
authors.forename: Justin
authors.initials: J
authors.lastname: Price
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods* / Q000401:mortality; D018572:Disease-Free Survival; D006349:Heart Valve Diseases / Q000150:complications* / Q000401:mortality; D006350:Heart Valve Prosthesis; D006801:Humans; D008943:Mitral Valve; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality