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2 . 2021

Atrial fibrillation radiofrequency ablation: influence of mitral valve initial pathology

Abstract

Aim - to assess the influence of the mitral valve initial pathology on the effectiveness of atrial fibrillation (AF) radiofrequency ablation.

Material and methods. From January 2011 to December 2017 simultaneous atrial fibrillation ablation was performed during mitral valve surgery on 180 patients in our center. The mean age was 57.6±8.96 (29-79) years old, there were 66 males, 114 females. Preoperatively a longstanding persistent form of AF was in 113 (62.8%) patients, paroxysmal and persistent forms were in 34 (18.9%) and 33 (18.3%) patients, respectively. However, 44 (24.4%) patients had a sinus rhythm before the operation. According to the clinical and morphological features of the mitral valve lesion, all patients were divided into two groups: the first group included 93 (51.7%) patients with predominant rheumatic mitral stenosis, and the second one - 87 (48.3%) patients with predominant degenerative mitral valve insufficiency.

Results. Hospital mortality was 1.7% (3 patients). Mitral valve replacement was performed in 148 (83.6%) patients, valve repair - in 29 (16.4%). Maze IV procedure was carried out in 129 (72.9%) cases, left atrial maze - in 45 (27.1%) cases and pulmonary vein isolation - in 3 (1.7%). A pacemaker implantation after operation was required in 16 (9%) patients. At discharge, freedom of AF was 81.9% (145 patients). The effectiveness of ablation depended on the initial form of AF: the biggest was at paroxysmal form (100%), less - in persistent form (81.3%) and the worst -in longstanding persistent one (76.6%). The freedom of AF for the group with mitral stenosis was 80% (72 patients) but for the mitral valve insufficiency group - 83.9% (73 patients) (p=0.56). 

Conclusion. The radiofrequency ablation is an effective method for the management of AF in patients who need mitral valve surgery. The effectiveness of the procedure depends on preoperative form of AF but not anatomical variant of mitral valve lesion.

Keywords:atrial fibrillation, mitral valve surgery, radiofrequency ablation

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Aminov V.V., Svetkin M.A., Lukin O.P. Atrial fibrillation radiofrequency ablation: influence of mitral valve initial pathology. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (2): 36-45. DOI: https://doi.org/10.33029/2308-1198-2021-9-2-36-45 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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