Radiofrequency ablation of atrial fibrillation in patients with mitral or aortic mechanical prosthetic valves: A feasibility, safety, and efficacy study

Dhanunjaya Lakkireddy, Darbhamulla Nagarajan, Luigi Di Biase, Subba Reddy Vanga, Srijoy Mahapatra, T. Jared Bunch, John D. Day, David J. Burkhardt, Linda Umbarger, Raghuveer Dendi, Rhea Pimentel, Loren Berenbom, Martin Emert, Anna Gerken, Sudharani Bommana, Wallace Ray, Donita Atkins, Caroline Murray, Buddhadeb Dawn, Andrea Natale

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Patients with prosthetic valves have a high prevalence of atrial fibrillation (AF). We report a multicenter experience of performing pulmonary vein antral isolation (PVAI) in this challenging, high-risk cohort of patients. Objective: The purpose of this study was to assess the feasibility, safety, and efficacy of radiofrequency (RF) ablation for sinus rhythm restoration in AF patients with mitral or aortic mechanical prosthetic valves. Methods: A total of 50 patients with prosthetic valves (group I) who underwent RF ablation for AF between January 1, 2007, and April 30, 2009, were identified prospectively at four tertiary care centers. A matched group of 50 patients (group II) acted as controls. Results: Total procedural time (199.4 ± 49 minutes vs 166.6 ± 27.5 minutes, P <.001) and fluoroscopy time (60 ± 17 minutes vs 53.8 ± 6.8 minutes, P <.01) were prolonged, with a higher incidence of atrial flutter at 3 months in group I (18% vs 6%, P = .1) compared to group II. At 12 months, 80% of patients in the valve group were in sinus rhythm after an average of 1.3 procedures, and 82% of controls were in sinus rhythm after an average 1.2 procedures (P = .9). There was a trend toward a higher nonfatal complication rate in the valve group than in the control group (8% vs 4%, P = .1). Conclusion: In patients with prosthetic valves, RF ablation for AF is feasible, safe, and efficacious, with a trend toward a higher nonfatal complication rate and an increased rate of postablation atrial flutter.

Original languageEnglish (US)
Pages (from-to)975-980
Number of pages6
JournalHeart Rhythm
Volume8
Issue number7
DOIs
StatePublished - Jul 2011
Externally publishedYes

Fingerprint

Atrial Fibrillation
Safety
Atrial Flutter
Pulmonary Veins
Fluoroscopy
Tertiary Care Centers
Research Design
Control Groups
Incidence

Keywords

  • Atrial fibrillation
  • Prosthetic valve
  • Radiofrequency ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Radiofrequency ablation of atrial fibrillation in patients with mitral or aortic mechanical prosthetic valves : A feasibility, safety, and efficacy study. / Lakkireddy, Dhanunjaya; Nagarajan, Darbhamulla; Di Biase, Luigi; Vanga, Subba Reddy; Mahapatra, Srijoy; Jared Bunch, T.; Day, John D.; Burkhardt, David J.; Umbarger, Linda; Dendi, Raghuveer; Pimentel, Rhea; Berenbom, Loren; Emert, Martin; Gerken, Anna; Bommana, Sudharani; Ray, Wallace; Atkins, Donita; Murray, Caroline; Dawn, Buddhadeb; Natale, Andrea.

In: Heart Rhythm, Vol. 8, No. 7, 07.2011, p. 975-980.

Research output: Contribution to journalArticle

Lakkireddy, D, Nagarajan, D, Di Biase, L, Vanga, SR, Mahapatra, S, Jared Bunch, T, Day, JD, Burkhardt, DJ, Umbarger, L, Dendi, R, Pimentel, R, Berenbom, L, Emert, M, Gerken, A, Bommana, S, Ray, W, Atkins, D, Murray, C, Dawn, B & Natale, A 2011, 'Radiofrequency ablation of atrial fibrillation in patients with mitral or aortic mechanical prosthetic valves: A feasibility, safety, and efficacy study', Heart Rhythm, vol. 8, no. 7, pp. 975-980. https://doi.org/10.1016/j.hrthm.2011.02.012
Lakkireddy, Dhanunjaya ; Nagarajan, Darbhamulla ; Di Biase, Luigi ; Vanga, Subba Reddy ; Mahapatra, Srijoy ; Jared Bunch, T. ; Day, John D. ; Burkhardt, David J. ; Umbarger, Linda ; Dendi, Raghuveer ; Pimentel, Rhea ; Berenbom, Loren ; Emert, Martin ; Gerken, Anna ; Bommana, Sudharani ; Ray, Wallace ; Atkins, Donita ; Murray, Caroline ; Dawn, Buddhadeb ; Natale, Andrea. / Radiofrequency ablation of atrial fibrillation in patients with mitral or aortic mechanical prosthetic valves : A feasibility, safety, and efficacy study. In: Heart Rhythm. 2011 ; Vol. 8, No. 7. pp. 975-980.
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abstract = "Background: Patients with prosthetic valves have a high prevalence of atrial fibrillation (AF). We report a multicenter experience of performing pulmonary vein antral isolation (PVAI) in this challenging, high-risk cohort of patients. Objective: The purpose of this study was to assess the feasibility, safety, and efficacy of radiofrequency (RF) ablation for sinus rhythm restoration in AF patients with mitral or aortic mechanical prosthetic valves. Methods: A total of 50 patients with prosthetic valves (group I) who underwent RF ablation for AF between January 1, 2007, and April 30, 2009, were identified prospectively at four tertiary care centers. A matched group of 50 patients (group II) acted as controls. Results: Total procedural time (199.4 ± 49 minutes vs 166.6 ± 27.5 minutes, P <.001) and fluoroscopy time (60 ± 17 minutes vs 53.8 ± 6.8 minutes, P <.01) were prolonged, with a higher incidence of atrial flutter at 3 months in group I (18{\%} vs 6{\%}, P = .1) compared to group II. At 12 months, 80{\%} of patients in the valve group were in sinus rhythm after an average of 1.3 procedures, and 82{\%} of controls were in sinus rhythm after an average 1.2 procedures (P = .9). There was a trend toward a higher nonfatal complication rate in the valve group than in the control group (8{\%} vs 4{\%}, P = .1). Conclusion: In patients with prosthetic valves, RF ablation for AF is feasible, safe, and efficacious, with a trend toward a higher nonfatal complication rate and an increased rate of postablation atrial flutter.",
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T1 - Radiofrequency ablation of atrial fibrillation in patients with mitral or aortic mechanical prosthetic valves

T2 - A feasibility, safety, and efficacy study

AU - Lakkireddy, Dhanunjaya

AU - Nagarajan, Darbhamulla

AU - Di Biase, Luigi

AU - Vanga, Subba Reddy

AU - Mahapatra, Srijoy

AU - Jared Bunch, T.

AU - Day, John D.

AU - Burkhardt, David J.

AU - Umbarger, Linda

AU - Dendi, Raghuveer

AU - Pimentel, Rhea

AU - Berenbom, Loren

AU - Emert, Martin

AU - Gerken, Anna

AU - Bommana, Sudharani

AU - Ray, Wallace

AU - Atkins, Donita

AU - Murray, Caroline

AU - Dawn, Buddhadeb

AU - Natale, Andrea

PY - 2011/7

Y1 - 2011/7

N2 - Background: Patients with prosthetic valves have a high prevalence of atrial fibrillation (AF). We report a multicenter experience of performing pulmonary vein antral isolation (PVAI) in this challenging, high-risk cohort of patients. Objective: The purpose of this study was to assess the feasibility, safety, and efficacy of radiofrequency (RF) ablation for sinus rhythm restoration in AF patients with mitral or aortic mechanical prosthetic valves. Methods: A total of 50 patients with prosthetic valves (group I) who underwent RF ablation for AF between January 1, 2007, and April 30, 2009, were identified prospectively at four tertiary care centers. A matched group of 50 patients (group II) acted as controls. Results: Total procedural time (199.4 ± 49 minutes vs 166.6 ± 27.5 minutes, P <.001) and fluoroscopy time (60 ± 17 minutes vs 53.8 ± 6.8 minutes, P <.01) were prolonged, with a higher incidence of atrial flutter at 3 months in group I (18% vs 6%, P = .1) compared to group II. At 12 months, 80% of patients in the valve group were in sinus rhythm after an average of 1.3 procedures, and 82% of controls were in sinus rhythm after an average 1.2 procedures (P = .9). There was a trend toward a higher nonfatal complication rate in the valve group than in the control group (8% vs 4%, P = .1). Conclusion: In patients with prosthetic valves, RF ablation for AF is feasible, safe, and efficacious, with a trend toward a higher nonfatal complication rate and an increased rate of postablation atrial flutter.

AB - Background: Patients with prosthetic valves have a high prevalence of atrial fibrillation (AF). We report a multicenter experience of performing pulmonary vein antral isolation (PVAI) in this challenging, high-risk cohort of patients. Objective: The purpose of this study was to assess the feasibility, safety, and efficacy of radiofrequency (RF) ablation for sinus rhythm restoration in AF patients with mitral or aortic mechanical prosthetic valves. Methods: A total of 50 patients with prosthetic valves (group I) who underwent RF ablation for AF between January 1, 2007, and April 30, 2009, were identified prospectively at four tertiary care centers. A matched group of 50 patients (group II) acted as controls. Results: Total procedural time (199.4 ± 49 minutes vs 166.6 ± 27.5 minutes, P <.001) and fluoroscopy time (60 ± 17 minutes vs 53.8 ± 6.8 minutes, P <.01) were prolonged, with a higher incidence of atrial flutter at 3 months in group I (18% vs 6%, P = .1) compared to group II. At 12 months, 80% of patients in the valve group were in sinus rhythm after an average of 1.3 procedures, and 82% of controls were in sinus rhythm after an average 1.2 procedures (P = .9). There was a trend toward a higher nonfatal complication rate in the valve group than in the control group (8% vs 4%, P = .1). Conclusion: In patients with prosthetic valves, RF ablation for AF is feasible, safe, and efficacious, with a trend toward a higher nonfatal complication rate and an increased rate of postablation atrial flutter.

KW - Atrial fibrillation

KW - Prosthetic valve

KW - Radiofrequency ablation

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