Safety and effectiveness of catheter ablation of atrial fibrillation in
patients with mitral valve replacement mechanical versus bioprosthetic
valves
Abstract
Introduction: The safety and effectiveness of catheter ablation
in patients with atrial fibrillation (AF) who underwent mechanical
mitral valve replacement (MVR) have been reported. However, the impacts
of different types of mitral valves on the safety and effectiveness of
catheter ablation in patients with AF who underwent MVR have not been
elucidated. Methods and results: From 2015 to 2021, 17,496
patients underwent catheter ablation of AF for the first time in Beijing
Anzhen Hospital were screened. The inclusion criteria were (1) aged 18
years or older; (2) diagnosed with AF; (3) history of mitral valve
replacement. The exclusion criteria were a history of catheter ablation,
surgical maze procedure, left atrial appendage closure or resection. A
total of 68 patients were enrolled in the study. The patients were
divided into two groups: the bioprosthetic MVR group (n=12) and the
mechanical MVR group(n=58). The size of the left atrial was larger
(49.5mm vs. 46.0mm, p<0.05), the thickness of the left
interventricular septum was larger (11.0mm vs. 10.0mm,
p<0.05), and the mitral ring area was smaller (2.3mm2 vs.
2.6mm2, p<0.05) for the bioprosthetic MVR group than the
mechanical MVR group. During 23.4 (6.1, 36.5) months of follow-up, the
incidence of the endpoint events was not significantly different between
the two groups (33.3% vs. 30.4%, log-rank p=0.48). There were 2 cases
(3.4%) of pseudoaneurysm and 1 case of acute cerebral infarction in the
mechanical MVR group. No complication was observed in the bioprosthetic
MVR group. No significant clinical bleeding events were observed in the
bioprosthetic group while eight patients in the mechanical MVR groups
had bleeding events (p=0.368) during the follow-up. Conclusion:
The safety and effectiveness of catheter ablation of AF were comparable
between the patients with mechanical MVR and bioprosthetic MVR.