TY - JOUR
T1 - Long-term outcomes of catheter ablation of atrial fibrillation post-cardiac valve replacement
AU - Zhao, Liang
AU - Xu, Kai
AU - Jiang, Weifeng
AU - Zhou, Li
AU - Wang, Yuanlong
AU - Zhang, Xiaodong
AU - Wu, Shaohui
AU - Zhang, Daoliang
AU - Liu, Xu
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd
PY - 2016/12/15
Y1 - 2016/12/15
N2 - Objective The long-term outcomes of catheter ablation of atrial fibrillation (AF) developing post-cardiac valve replacement (VR) remain undefined. Methods and results Eighty-nine post-VR patients with AF (44% longstanding persistent AF, LSP-AF) were enrolled. Cumulative success rate of circumferential pulmonary vein ablation (CPVA for paroxysmal AF) and bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs for persistent and LSP-AF) as index and repeat procedural endpoints reached 57% (mean, 1.3 procedures) during the first year, and dropped to 42% at median follow-up of 40 months (range, 24–70 months) for multiple procedures (mean, 1.6 ± 0.9 [1–5]); incidence of procedural complications was similar to that of conventional procedures. In multivariate analysis, larger right atrium (RA, 9.40 [2.64–33.36]; P = 0.001) and rheumatic valvular disease etiology (OR, 5.49 [95% CI, 1.26–23.96]; P = 0.023) were significant independent predictors of recurrent atrial tachyarrhythmia (ATa); in contrast, long-term freedom from ATa was comparable between single and double valve replacement groups (42.1% vs. 43.7%, P = 0.880), or mechanical and bioprosthetic valves groups (41.7% vs. 50.0%, P = 0.620). Conclusion In this single-center prospective study, treatment of post-VR AF with commonly used ablation strategies including CPVA and linear and CFAE ablation had limited long-term success, with ATa recurrence risk appearing higher in the setting of RA enlargement and rheumatic valvular disease and unrelated to valves characteristics.
AB - Objective The long-term outcomes of catheter ablation of atrial fibrillation (AF) developing post-cardiac valve replacement (VR) remain undefined. Methods and results Eighty-nine post-VR patients with AF (44% longstanding persistent AF, LSP-AF) were enrolled. Cumulative success rate of circumferential pulmonary vein ablation (CPVA for paroxysmal AF) and bidirectional block of lines and disappearance of complex fractionated atrial electrograms (CFAEs for persistent and LSP-AF) as index and repeat procedural endpoints reached 57% (mean, 1.3 procedures) during the first year, and dropped to 42% at median follow-up of 40 months (range, 24–70 months) for multiple procedures (mean, 1.6 ± 0.9 [1–5]); incidence of procedural complications was similar to that of conventional procedures. In multivariate analysis, larger right atrium (RA, 9.40 [2.64–33.36]; P = 0.001) and rheumatic valvular disease etiology (OR, 5.49 [95% CI, 1.26–23.96]; P = 0.023) were significant independent predictors of recurrent atrial tachyarrhythmia (ATa); in contrast, long-term freedom from ATa was comparable between single and double valve replacement groups (42.1% vs. 43.7%, P = 0.880), or mechanical and bioprosthetic valves groups (41.7% vs. 50.0%, P = 0.620). Conclusion In this single-center prospective study, treatment of post-VR AF with commonly used ablation strategies including CPVA and linear and CFAE ablation had limited long-term success, with ATa recurrence risk appearing higher in the setting of RA enlargement and rheumatic valvular disease and unrelated to valves characteristics.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Rheumatic valvular disease
KW - Right atrial enlargement
KW - Valve replacement
UR - http://www.scopus.com/inward/record.url?scp=84989323284&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84989323284&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2016.09.115
DO - 10.1016/j.ijcard.2016.09.115
M3 - Article
C2 - 27716555
AN - SCOPUS:84989323284
SN - 0167-5273
VL - 225
SP - 82
EP - 86
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -