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CLINICAL RESEARCH: ABLATION OF ATRIAL FIBRILLATION

Transcatheter radiofrequency ablation of atrial fibrillation in patients with mitral valve prostheses and enlarged atria

Safety, feasibility, and efficacy

Division of Cardiac Pacing and Arrhythmias, San Raffaele Hospital, Milan, Italy

Manuscript received July 2, 2004; revised manuscript received October 8, 2004, accepted November 22, 2004.

^* Reprint requests and correspondence: Dr. Carlo Pappone, Department of Cardiology, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy (Email: carlo.pappone{at}hsr.it; vincenzo.santinelli{at}hsr.it).

OBJECTIVES: Few data have been published on transcatheter ablation of atrial fibrillation (AF) in patients with mitral valve prostheses. Thus, we sought to report our experience.

BACKGROUND: Ablation is an effective treatment for AF. Patients with prosthetic mitral valves represent a special group because of an increased risk from the ablation procedure due to the possibility of damage to the prosthetic valve.

METHODS: Between July 2001 and July 2003, 26 patients with mitral valve prostheses (MVP) underwent circumferential pulmonary vein ablation for AF. A matched group of 52 ablated patients without MVP acted as control subjects. After a blanking period of three months, a follow-up of 12 months was considered for MVP patients and controls. Holter recordings were performed in all subjects at 3, 6, and 12 months.

RESULTS: Radiation exposure was higher in the MVP group, with fluoroscopy times of 35.3 ± 21 min versus 20.9 ± 15 min in controls. At the end of follow-up, 73% of MVP patients were in sinus rhythm, compared with 75% of controls. Atrial tachycardia occurred in six (23%) MVP patients, requiring repeat ablation in three, and one (2%) control subject, which settled without treatment. One transient ischemic attack and one femoral pseudoaneurysm occurred in the MVP group. No complications occurred in the control group.

CONCLUSIONS: Ablation of AF in patients with MVP is feasible, with outcomes similar to those of standard patients. Complications were higher among MVP patients with a greater radiation exposure and a higher incidence of post-ablation atrial tachycardia.

Abbreviations and Acronyms   ACT = activated clotting time   AF = atrial fibrillation   AT = atrial tachycardia   CPVA = circumferential pulmonary vein ablation   LA = left atrial/atrium   LV = left ventricular/ventricle   MVP = mitral valve prosthesis

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