Rhythm Outcome Predictors after Concomitant Ablation during Mitral Valve Surgery

Background: Mitral valve disease is strongly associated with the development of atrial fibrillation (AF). Concomitant ablation is an established procedure in patients with AF undergoing cardiac surgery. Therefore, we analyzed rhythm outcome and predictors of freedom from AF in patients undergoing concomitant surgical ablation during mitral valve surgery.

Method: A total of 496 patients who underwent mitral valve surgery and concomitant surgical ablation between 2003 and 2020 and had a 1-year follow-up were retrospectively analyzed. A total of 188 (37.9%) patients had paroxysmal and 308 (62.1%) persistent/longstanding-persistent AF. Radiofrequency ablation was performed in 389 (78.4%) patients and cryoablation in 107 patients (21.6%). The lesions were either limited to a pulmonary vein isolation (n = 67, 13.5%), a complete left atrial lesion set (n = 312, 62.9%), or biatrial ablation (n = 117, 23.6%). Follow-up rhythm evaluations were based on either 24 hour-Holter ECG or event recorder interrogation at 12 months postoperatively.

Results: Mean patients age was 74.83 ± 11.6, 55.8% were male. No ablation-related complications occurred in any of the patients. Overall, at 1-year follow-up freedom from AF was achieved in 312 (62.9%) patients, showing significantly better results in patients with paroxysmal AF compared with those with persistent/longstanding-persistent AF (73.9 vs. 56.2%; p < 0.001). Logistic regression analysis revealed sinus rhythm at discharge (odds ratio: 2.604, 95% CI: 1.676–4.048, p < 0.001) and paroxysmal AF (odds ratio: 2.031, 95% CI: 1.323–3.120, p = 0.001) as statistically significant predictors for freedom from AF. Regarding energy sources, those receiving cryoablation showed significantly higher rates of freedom from AF compared with patients receiving bipolar ablation (cryoablation: 71.0% vs. radiofrequency ablation: 60.7%, p = 0.049).

Conclusion: Concomitant ablation during mitral valve surgery is a safe and effective procedure for the treatment of AF. Freedom from AF was achieved in 62.9% of the patient. Sinus rhythm at discharge and paroxysmal AF were statistically significant predictors for freedom from AF.

Publication History

Article published online:
28 January 2023