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.
Keywords: atrial fibrillation; mechanical mitral valve
replacement; bioprosthetic mitral valve replacement; catheter ablation;
safety and effectiveness