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

Rong Bai, Luigi Di Biase, Prasant Mohanty, Pasquale Santangeli, Sanghamitra Mohanty, Agnes Pump, Claude S. Elayi, Yeruva Madhu Reddy, Giovanni B. Forleo, Richard Hongo, Salwa Beheiry, Antonio Dello Russo, Michela Casella, Gemma Pelargonio, Pietro Santarelli, Rodney Horton, Javier Sanchez, Joseph Gallinghouse, J. David Burkhardt, Changsheng MaDhanunjaya Lakkireddy, Claudio Tondo, Andrea Natale

Research output: Contribution to journalArticle

Abstract

Long-Term Outcome of AF Ablation in MMV Patients Introduction 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. Methods and 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). Conclusion 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.

Original languageEnglish
Pages (from-to)824-833
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Volume25
Issue number8
DOIs
Publication statusPublished - 2014

Keywords

  • atrial fibrillation
  • atrial tachycardia
  • catheter ablation
  • mechanical mitral valve
  • pulmonary vein isolation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

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    Bai, R., Di Biase, L., Mohanty, P., Santangeli, P., Mohanty, S., Pump, A., Elayi, C. S., Reddy, Y. M., Forleo, G. B., Hongo, R., Beheiry, S., Russo, A. D., Casella, M., Pelargonio, G., Santarelli, P., Horton, R., Sanchez, J., Gallinghouse, J., Burkhardt, J. D., ... Natale, A. (2014). 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. Journal of Cardiovascular Electrophysiology, 25(8), 824-833. https://doi.org/10.1111/jce.12433