Catheter ablation of atrial fibrillation in patients with mechanical mitral valve: long-term outcome of single procedure of pulmonary vein antrum isolation with or without nonpulmonary vein trigger ablation.
BACKGROUND
It is unclear whether extended pulmonary vein antrum isolation (PVAI) plus nonpulmonary vein (non-PV) trigger elimination prevents more arrhythmia recurrence than PVAI alone in patients with mechanical mitral valve (MMV) undergoing AF ablation. This study compared the efficacy and long-term outcome of 2 ablation strategies--PVAI alone versus extended PVAI plus non-PV trigger elimination--for the treatment of AF in patients with MMV.


RESULTS
One hundred and nine consecutive AF patients with MMV were divided into 2 groups: standard PVAI was performed in group 1 (N = 45); in group 2 (N = 64) PVAI was extended to the LA posterior wall, LA septum, and CS; and all non-PV triggers were eliminated. Patients were followed up for 3 years. At the 12th month, 7 (15.6%) patients in group 1, and 39 (60.9%) patients in group 2 were arrhythmia free (log-rank P < 0.001). Four patients (8.9%; 3 cases of AT and 1 case of AF) from group 1, and 12 patients (18.8%; 9 cases of AT, and 3 cases of AFL) from group 2 experienced very late recurrence. At 36 ± 7 months follow-up, the cumulative recurrence after a single procedure was 42/45 (93.3%) in group 1, and 37/64 (57.8%) in group 2 (log-rank P < 0.001).


CONCLUSIONS
Compared with the standard PVAI alone, a strategy including extended PVAI and non-PV trigger elimination is associated with a higher 12-month and long-term arrhythmia-free survival in patients with MMV undergoing AF ablation. Very late recurrence may occur years after the initial procedure with focal AT as the most common type of recurrent arrhythmia.
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.|Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Rong
R
Bai
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.|Department of Cardiology, University of Foggia, Foggia, Italy.|Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.|Albert Einstein College of Medicine at Montefiore Hospital, New York, USA.
Luigi
L
DI Biase
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
Prasant
P
Mohanty
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
Pasquale
P
Santangeli
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
Sanghamitra
S
Mohanty
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.|Heart Institute, Faculty of Medicine, University of Pecs, Pecs, Hungary.
Agnes
A
Pump
Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky, USA.
Claude S
CS
Elayi
Center for Excellence in Atrial Fibrillation and EP Research, Bloch Heart Rhythm Center, Mid-America Cardiology at Kansas University Hospital, Kansas City, Kansas, USA.
Yeruva Madhu
YM
Reddy
Division of Cardiology, University Hospital of Tor Vergata, Rome, Italy.
Giovanni B
GB
Forleo
Division of Electrophysiology, California Pacific Medical Center, San Francisco, California, USA.
Richard
R
Hongo
Division of Electrophysiology, California Pacific Medical Center, San Francisco, California, USA.
Salwa
S
Beheiry
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Antonio Dello
AD
Russo
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Michela
M
Casella
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Gemma
G
Pelargonio
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Pietro
P
Santarelli
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.|Department of Biomedical Engineering, University of Texas, Austin, Texas, USA.
Rodney
R
Horton
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
Javier
J
Sanchez
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
Joseph
J
Gallinghouse
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
J David
JD
Burkhardt
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Changsheng
C
Ma
Center for Excellence in Atrial Fibrillation and EP Research, Bloch Heart Rhythm Center, Mid-America Cardiology at Kansas University Hospital, Kansas City, Kansas, USA.
Dhanunjaya
D
Lakkireddy
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Claudio
C
Tondo
Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.|Division of Electrophysiology, California Pacific Medical Center, San Francisco, California, USA.|Department of Biomedical Engineering, University of Texas, Austin, Texas, USA.|Division of Cardiology, Stanford University, Palo Alto, California, USA.|Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA.
Andrea
A
Natale
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002681:China; D018572:Disease-Free Survival; D022062:Electrophysiologic Techniques, Cardiac; D005060:Europe; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D011474:Prosthesis Design; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
atrial fibrillation; atrial tachycardia; catheter ablation; mechanical mitral valve; pulmonary vein isolation