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Catheter Ablation for Atrial Fibrillation in Structural Heart Disease: A Review. J Clin Med 2023; 12:jcm12041431. [PMID: 36835964 PMCID: PMC9966488 DOI: 10.3390/jcm12041431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Patients with structural heart disease (SHD) are at an increased risk of developing this arrhythmia and are particularly susceptible to the deleterious hemodynamic effects it carries. In the last two decades, catheter ablation (CA) has emerged as a valuable strategy for rhythm control and is currently part of the standard care for symptomatic relief in patients with AF. Growing evidence suggests that CA of AF may have potential benefits that extend beyond symptoms. In this review, we summarize the current knowledge of this intervention on SHD patients.
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Almorad A, O'Neill L, Wielandts JY, Gillis K, De Becker B, Nakatani Y, De Asmundis C, Iacopino S, Pambrun T, Marc LM, Jaïs P, Haïssaguerre M, Duytschaever M, Chierchia JB, Derval N, Knecht S. Long-term clinical outcome of atrial fibrillation ablation in patients with history of mitral valve surgery. Front Cardiovasc Med 2022; 9:928974. [PMID: 36620626 PMCID: PMC9811118 DOI: 10.3389/fcvm.2022.928974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
Aims Atrial fibrillation (AF) occurs frequently after mitral valve (MV) surgery. This study aims to evaluate the efficacy and long-term clinical outcomes after the first AF ablation in patients with prior MV surgery. Methods Sixty consecutive patients with a history of MV surgery without MAZE referred to three European centers for a first AF ablation between 2007 and 2017 (group 1) were retrospectively enrolled. They were matched (propensity score match) with 60 patients referred for AF ablation without prior MV surgery (group 2). Results After the index ablation, 19 patients (31.7%) from group 1 and 24 (40%) from group 2 had no recurrence of atrial arrhythmias (ATa) (p = 0.3). After 62 (48-84) months of follow-up and 2 (2-2) procedures, 90.0% of group 1 and 95.0% of group 2 patients were in sinus rhythm (p = 0.49). In group 1, 19 (31.7%) patients had mitral stenosis, and 41 (68.3%) had mitral regurgitation. Twenty-seven (45.0%) patients underwent mechanical valve replacement and 33 (55.0%) MV annuloplasty. At the final follow-up, 28 (46.7%) and 33 (55.0%) patients were off antiarrhythmic drugs (p = 0.46). ATa recurrence was seen more commonly in patients with prior MV surgery (54 vs. 22%, respectively, p < 0.05). No major complication occurred. Conclusion Long-term freedom of atrial arrhythmias after atrial fibrillation catheter ablation is achievable and safe in patients with a history of mitral valve surgery. In AF patients without a history of mitral valve surgery, repeated procedures are needed to maintain sinus rhythm.
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Affiliation(s)
- Alexandre Almorad
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium,Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium,*Correspondence: Alexandre Almorad ✉
| | - Louisa O'Neill
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium
| | | | - Kris Gillis
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium
| | | | - Yosuke Nakatani
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Saverio Iacopino
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Thomas Pambrun
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - La Meir Marc
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Pierre Jaïs
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Michel Haïssaguerre
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | | | - Jean-Baptista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, Hospital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Avenue de Magellan, Pessac, France
| | - Sébastien Knecht
- Department of Cardiology, AZ Sint Jan Hospital Bruges, Bruges, Belgium,Sébastien Knecht ✉
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Bertels J, Rottner L, Heeger CH, Maurer T, Reissmann R, Ouyang F, Mathew S, Wohlmuth P, Schlüter M, Kuck KH, Metzner A, Lemeš C. Acute and long-term success of left atrial anterior line and mitral isthmus line ablation in patients after mitral valve surgery. Pacing Clin Electrophysiol 2022; 45:1024-1031. [PMID: 35822917 DOI: 10.1111/pace.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/04/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perimitral flutter and atrial fibrillation may occur in patients with prior surgical mitral valve (MV) repair or replacement and can be challenging for percutaneous catheter ablation. This study sought to determine the feasibility, acute success and durability of catheter ablation of atrial fibrillation or atrial tachycardia by way of a mitral isthmus line (MIL) or an anterior line (AL). METHODS A total of 81 patients (49 males, mean age 62±11 years) with prior MV replacement (n = 30) or reconstruction (n = 51) underwent creation of a MIL (34) and/or an AL (72). RESULTS Acute bidirectional block of the MIL was successfully achieved in 24/34 cases and of the AL in 64/72 patients. Patients of the control group without prior MV surgery were matched 1:1 with the valve group. In the AL control subgroup, acute bidirectional block was achieved in 65/72 patients. Acute blockage in the MIL control subgroup could be achieved in 31/34 patients. The MIL valve subgroup showed the worst results in terms of durability, whereas a similar trend emerged in the control group and the AL valve subgroup (probability of failure in MIL valve subgroup 2.224 vs. MIL control subgroup 0.605 [Hazard Ratio (HR) = 0.27, 95% confidence interval (CI), 0.11-0.65), p = 0.004]; probability of failure in AL valve subgroup 0.844 vs. AL control subgroup 1.03 [HR = 1.22 (95% CI, 0.66-2.26), p = 0.523]). CONCLUSIONS Percutaneous creation of MIL and AL is feasible and safe in patients with prior MV replacement/repair and associated with moderate acute and long-term success rates to achieve bidirectional block. This article is protected by copyright. All rights reserved.
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Marazzato J, Cappabianca G, Angeli F, Crippa M, Golino M, Ferrarese S, Beghi C, De Ponti R. Catheter ablation of atrial tachycardias after mitral valve surgery: A systematic review and meta‐analysis. J Cardiovasc Electrophysiol 2020; 31:2632-2641. [DOI: 10.1111/jce.14666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 01/27/2023]
Affiliation(s)
- Jacopo Marazzato
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | | | - Fabio Angeli
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
- Department of Medicine and Cardiopulmonary Rehabilitation Maugeri Care and Research Institutes, IRCCS Tradate Varese Italy
| | - Matteo Crippa
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Michele Golino
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Cesare Beghi
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
| | - Roberto De Ponti
- Department of Medicine and Surgery, Ospedale di Circolo University of Insubria Varese Italy
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Yildiz M. The Impact Of Real-Time Three Dimensional Transoesophageal Echocardiography Before Transcatheter Radiofrequency Ablation Of Atrial Fibrillation In Patients With Prosthetic Mechanical Mitral Valve. J Atr Fibrillation 2015; 8:1255. [PMID: 27957204 DOI: 10.4022/jafib.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation is the most common arrhythmia following valvular heart surgery. Radiofrequence catheter ablation of atrial fibrillation in patients with prothetic mechanical mitral valve is feasible and relatively safe in experienced center. Implementation of real-time three dimensional transoesophageal echocardiography in atrial fibrillation can demonstrate on-line left atrial and left atrial appendix spontaneous echo contrast and thrombus. This condition makes the electrophysiologist allerted for the expected complications.
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Affiliation(s)
- Mustafa Yildiz
- Department of Cardiology, Istanbul University Cardiology Institute, Istanbul, Turkey
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Bartoletti S, Santangeli P, DI Biase L, Natale A. Catheter Ablation of Atrial Fibrillation in Patients with Hardware in the Heart - Septal Closure Devices, Mechanical Valves and More. J Atr Fibrillation 2013; 6:851. [PMID: 28496857 PMCID: PMC5153066 DOI: 10.4022/jafib.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/05/2013] [Accepted: 05/28/2013] [Indexed: 06/07/2023]
Abstract
Patients with mechanical "hardware" in the heart, such as those with mechanical cardiac valves or atrial septal closure devices, represent a population at high risk of developing AF. Catheter ablation of AF in these subjects might represent a challenge, due to the perceived higher risk of complications associated with the presence of intracardiac mechanical devices. Accordingly, such patients were excluded or poorly represented in major trials proving the benefit of catheter ablation for the rhythm-control of AF. However, recent evidence supports the concept that catheter ablation procedures might be equally effective in these patients, without a significant increase in the risk of procedural complications. This review will summarize the current state-of-the-art on catheter ablation of AF in patients with mechanical "hardware" in the heart.
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Affiliation(s)
- Stefano Bartoletti
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome (Italy)
| | - Pasquale Santangeli
- Cardiac Arrhythmia Service, Stanford University School of Medicine, Stanford (CA)
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (TX)
- Cardiology Department, University of Foggia, Foggia (Italy)
| | - Luigi DI Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (TX)
- Cardiology Department, University of Foggia, Foggia (Italy)
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin (TX)
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