Radiofrequency Ablation of Atrial Fibrillation in Patients With Mitral or Aortic Mechanical Prosthetic Valves: A Feasibility, Safety, and Efficacy Study

Study Questions:

Can radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) be performed safely in patients with a prosthetic valve?

Methods:

Pulmonary vein antral isolation using a 3.5-mm irrigated-tip ablation catheter and a ring catheter for mapping the pulmonary veins was performed in 50 patients (mean age 62 years) with AF (persistent in 60%) and a mitral (90%) and/or aortic (10%) prosthetic valve. Complex atrial electrograms also were ablated in patients with persistent AF. Fifty age- and gender-matched patients without a prosthetic valve undergoing AF ablation served as a control group. All patients were followed for 12 months.

Results:

The mean international normalized ratio during the procedure was 2.8 in the prosthetic valve group. The mean procedure time (199 vs. 167 minutes) and duration of RFCA (48 vs. 36 minutes) were significantly longer in the prosthetic valve group. There were no fatal complications and no significant difference in the complication rate between the prosthetic valve (8%) and control (4%) groups. The redo ablation rate did not differ significantly between the prosthetic valve and control groups (89% and 67%, respectively). Efficacy off antiarrhythmic drugs at 12 months was similar in the prosthetic valve and control groups (80% vs. 82%, respectively).

Conclusions:

The authors concluded that the safety and efficacy of RFCA of AF are not compromised by the presence of a prosthetic mitral or aortic valve.

Perspective:

The risk of entrapment within a mechanical prosthetic mitral valve is very low for a conventional ablation catheter, but much higher for a ring catheter. To maximize safety, some operators forego the use of a ring catheter in patients with a prosthetic mitral valve.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: International Normalized Ratio, Heart Valve Prosthesis, Pulmonary Veins, Atrial Fibrillation, Electrophysiologic Techniques, Cardiac, Heart Valve Prosthesis Implantation, Heart Rate, Catheter Ablation, Mitral Valve


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