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. © 2014 Wiley Periodicals, Inc.
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 / 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.; Dello Russo, A.; Casella, M.; Pelargonio, G.; Santarelli, P.; Horton, R.; Sanchez, J.; Gallinghouse, J.; Burkhardt, J. D.; Ma, C.; Lakkireddy, D.; Tondo, C.; Natale, A.. - In: JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY. - ISSN 1045-3873. - 25:8(2014), pp. 824-833. [10.1111/jce.12433]
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
Dello Russo A.;Casella M.;
2014-01-01
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. © 2014 Wiley Periodicals, Inc.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.