title: Catheter ablation for atrial fibrillation after an unsuccessful surgical ablation and biological prosthetic mitral valve replacement: a pilot study.
abstract: BACKGROUND
  Patients with mitral valve (MV) disease and atrial fibrillation (AF) undergo simultaneous prosthetic valve replacement and radiofrequency (RF) ablation procedure; however, this combinational procedure restores sinus rhythm (SR) in only 68-82% of the cases. In patients with ineffective surgical ablation, the use of a biological prosthetic valve might not only be a good choice to perform safe catheter ablation procedure in the left atrium (LA), but also provide a way to discontinue administration of oral anticoagulants. The objective of this study was to assess the efficacy of catheter ablation for AF after MV replacement with a biological prosthesis and an ineffective surgical ablation procedure.
  
  
  METHODS
  Ten consecutive patients aged 48 ± 7 years were enrolled in this study. All patients had long-persistent AF associated with a rheumatic valve disease, which was treated by MV replacement with a biological prosthesis and a surgical RF ablation procedure. In the late postoperative period, all the patients had recurrent hemodynamically significant AF, which required repeated cardioversions. From 1 year to 3 years after the surgery, catheter ablation was performed, including reisolation of pulmonary veins (PVs) with the ablation of ganglionic plexi or linear lesions on the roof of the LA and mitral isthmus. The efficacy was assessed at 3 months, 6 months, and 12 months after the procedure.
  
  
  RESULTS
  Restoration of SR during ablation was achieved in all of the cases. In 6-9 months, all the patients were free of arrhythmia. LA stunning manifested by the absence or decrease of the "A" wave in the transmitral flow and the retrograde wave in the PV flow was observed in nine patients with SR. In five of the patients, LA contractile function was restored in 1-6 months. Prosthetic valve dysfunction was not detected in any of the patients.
  
  
  CONCLUSIONS
  Catheter ablation is an effective method for AF treatment following an ineffective surgical RF ablation procedure and biological prosthetic MV replacement. The use of bioprosthetic MVs allows for performing safe catheter ablation without subsequent prosthetic dysfunction.
authors.affiliation: Arrhythmology and Pacing Department, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation. Electronic address: mamchse@cardio.kem.ru.
authors.forename: Sergey E
authors.initials: SE
authors.lastname: Mamchur
authors.affiliation: Electrophysiology and Echography Department, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation.
authors.forename: Irina N
authors.initials: IN
authors.lastname: Mamchur
authors.affiliation: Arrhythmology and Pacing Department, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation.
authors.forename: Egor A
authors.initials: EA
authors.lastname: Khomenko
authors.affiliation: Arrhythmology and Pacing Department, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation.
authors.forename: Elena V
authors.initials: EV
authors.lastname: Gorbunova
authors.affiliation: Electrophysiology and Echography Department, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation.
authors.forename: Irina N
authors.initials: IN
authors.lastname: Sizova
authors.affiliation: Biological Prosthetic Valve Replacement Department, Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation.
authors.forename: Yury N
authors.initials: YN
authors.lastname: Odarenko
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D001705:Bioprosthesis; D017115:Catheter Ablation; D005260:Female; D006325:Heart Atria; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D010865:Pilot Projects; D011183:Postoperative Complications; D012214:Rheumatic Heart Disease / Q000601:surgery; D016896:Treatment Outcome
keywords: atrial fibrillation; catheter ablation; heart valve prosthesis