TY - JOUR
T1 - Feasibility of catheter ablation of mitral annular flutter in patients with prior mitral valve surgery
AU - Mountantonakis, Stavros
AU - Frankel, David S.
AU - Hutchinson, Mathew D.
AU - Dixit, Sanjay
AU - Riley, Michael
AU - Callans, David J.
AU - Garcia, Fermin
AU - Lin, David
AU - Tzou, Wendy
AU - Bala, Rupa
AU - Marchlinski, Francis E.
AU - Gerstenfeld, Edward P.
PY - 2011/6
Y1 - 2011/6
N2 - Background: Mitral annular flutter (MAF) may occur after ablation of atrial fibrillation in patients with prior mitral valve (MV) replacement or repair. Percutaneous catheter ablation may be challenging owing to the presence of surgical scar and a prosthetic MV. Objective: We examined the feasibility of and outcome after mitral isthmus ablation in patients with prior MV surgery. Methods: Twenty-one consecutive patients (18 males, age 61 ±10 years) with a history of MV surgery (nine replacement, 12 repair with annuloplasty ring) underwent catheter ablation of clinical (n = 17) or easily inducible (n = 4) MAF (group 1). Patients were matched for age, gender, and ejection fraction, with 21 patients undergoing MAF ablation without prior MV surgery (group 2). Irrigated ablation was delivered endocardially in a linear fashion from the MV to the left inferior and/or to the right superior pulmonary vein and, when required, epicardially inside the coronary sinus. Isolation of all pulmonary veins was also performed. Results: There was no difference in termination of tachycardia during ablation (group 1 vs. group 2; 86% vs. 71%; P = .454), achieving mitral isthmus block (71% vs. 71%; P = 1.000), or need for epicardial ablation (43% vs. 62%; P = .354) between groups. No complications occurred in either group. After a mean follow-up of 7 ± 4 months, 15 (71%) patients in group 1 and 14 (67%) in group 2 had no recurrence of atrial arrhythmias. Conclusions: Percutaneous mitral isthmus ablation is feasible and safe in patients with prior MV replacement or repair and has comparable outcomes to patients without prior MV surgery.
AB - Background: Mitral annular flutter (MAF) may occur after ablation of atrial fibrillation in patients with prior mitral valve (MV) replacement or repair. Percutaneous catheter ablation may be challenging owing to the presence of surgical scar and a prosthetic MV. Objective: We examined the feasibility of and outcome after mitral isthmus ablation in patients with prior MV surgery. Methods: Twenty-one consecutive patients (18 males, age 61 ±10 years) with a history of MV surgery (nine replacement, 12 repair with annuloplasty ring) underwent catheter ablation of clinical (n = 17) or easily inducible (n = 4) MAF (group 1). Patients were matched for age, gender, and ejection fraction, with 21 patients undergoing MAF ablation without prior MV surgery (group 2). Irrigated ablation was delivered endocardially in a linear fashion from the MV to the left inferior and/or to the right superior pulmonary vein and, when required, epicardially inside the coronary sinus. Isolation of all pulmonary veins was also performed. Results: There was no difference in termination of tachycardia during ablation (group 1 vs. group 2; 86% vs. 71%; P = .454), achieving mitral isthmus block (71% vs. 71%; P = 1.000), or need for epicardial ablation (43% vs. 62%; P = .354) between groups. No complications occurred in either group. After a mean follow-up of 7 ± 4 months, 15 (71%) patients in group 1 and 14 (67%) in group 2 had no recurrence of atrial arrhythmias. Conclusions: Percutaneous mitral isthmus ablation is feasible and safe in patients with prior MV replacement or repair and has comparable outcomes to patients without prior MV surgery.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Mitral annular flutter
KW - Mitral valve surgery
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U2 - 10.1016/j.hrthm.2011.01.019
DO - 10.1016/j.hrthm.2011.01.019
M3 - Article
C2 - 21236363
AN - SCOPUS:79957723210
SN - 1547-5271
VL - 8
SP - 809
EP - 814
JO - Heart Rhythm
JF - Heart Rhythm
IS - 6
ER -