Cardiothoracic Surgical Trials Network: Effectiveness of Surgical Ablation of AFib During MV Surgery
Atrial fibrillation (Afib) patients who received cardiac ablation to correct a leaky heart valve during surgery were less likely to experience additional Afib episodes after one year, according to a Late-Breaking Clinical Trial presented on Monday, March 16 as part of ACC.15 in San Diego, CA and research simultaneously published in the New England Journal of Medicine.
Researchers conducted a randomized 1:1 trial to assess the benefits of ablation in AFib patients with a leaky valve undergoing mitral valve surgery. Author A. Marc Gillinov, MD, FACC and his colleagues studied 260 persistent or long-standing persistent Afib patients from the Cardiothoracic Surgical Trials Network. Participants received either mitral valve surgery with surgical ablation or mitral valve surgery alone.
Results showed that 63 percent of patients who received mitral valve surgery plus ablation were free from Afib one year after surgery, versus 29 percent of patients who received surgery alone. Patients who received ablation were more likely to require a pacemaker than those who had valve surgery alone. However, those who had surgery alone described a lower quality of life, as they still experienced daily Afib.
“I think what this shows is that, in the mitral valve surgery patient who has persistent atrial fibrillation, you will achieve better rhythm control by performing ablation, without any increase in mortality or other adverse cardiac events,” Gillinov said.
Mitral valve surgery is not typically used as a treatment for Afib, but many valve replacement patients also have Afib and surgeons want to treat both issues at once.
“Although surgeons are widely performing ablation at the time of mitral valve surgery, there is a great deal of variation with regard to when it is done, how it is done and which patients receive it,” said Gillinov. “We sought to conduct a well-designed randomized controlled trial to answer fundamental questions about whether this procedure is successful and how it is best done.”
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