title: Long-term outcomes of catheter ablation of atrial fibrillation post-cardiac valve replacement.
abstract: OBJECTIVE
  The long-term outcomes of catheter ablation of atrial fibrillation (AF) developing post-cardiac valve replacement (VR) remain undefined.
  
  
  RESULTS
  Eighty-nine post-VR patients with AF (44% longstanding persistent AF, LSP-AF) were enrolled. Cumulative success rate of circumferential pulmonary vein ablation (CPVA for paroxysmal AF) and bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs for persistent and LSP-AF) as index and repeat procedural endpoints reached 57% (mean, 1.3 procedures) during the first year, and dropped to 42% at median follow-up of 40months (range, 24-70months) for multiple procedures (mean, 1.6±0.9 [1-5]); incidence of procedural complications was similar to that of conventional procedures. In multivariate analysis, larger right atrium (RA, 9.40 [2.64-33.36]; P=0.001) and rheumatic valvular disease etiology (OR, 5.49 [95% CI, 1.26-23.96]; P=0.023) were significant independent predictors of recurrent atrial tachyarrhythmia (ATa); in contrast, long-term freedom from ATa was comparable between single and double valve replacement groups (42.1% vs. 43.7%, P=0.880), or mechanical and bioprosthetic valves groups (41.7% vs. 50.0%, P=0.620).
  
  
  CONCLUSIONS
  In this single-center prospective study, treatment of post-VR AF with commonly used ablation strategies including CPVA and linear and CFAE ablation had limited long-term success, with ATa recurrence risk appearing higher in the setting of RA enlargement and rheumatic valvular disease and unrelated to valves characteristics.
authors.affiliation: Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China. Electronic address: xuliuchest@126.com.
authors.forename: Kai
authors.initials: K
authors.lastname: Xu
authors.affiliation: Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Weifeng
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Yuanlong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Shaohui
authors.initials: S
authors.lastname: Wu
authors.affiliation: Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Daoliang
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China. Electronic address: xuliuchest@126.com.
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000639:trends*; D015716:Electrocardiography, Ambulatory / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Rheumatic valvular disease; Right atrial enlargement; Valve replacement