Concomitant ablation of atrial fibrillation in rheumatic mitral valve surgery

Objective

Efficacy of atrial fibrillation ablation in rheumatic mitral valve disease has been regarded inferior to that in nonrheumatic diseases. This study aimed to evaluate net clinical benefits by the addition of concomitant atrial fibrillation ablation in rheumatic mitral valve surgery.

Methods

Among 1229 consecutive patients with atrial fibrillation from 1997 to 2016 (54.4 ± 11.7 years; 68.2% were female), 812 (66.1%) received concomitant ablation of atrial fibrillation (ablation group), and 417 (33.9%) underwent valve surgery alone (no ablation group). Death and thromboembolic events were compared between these groups. Mortality was regarded as a competing risk to evaluate thromboembolic outcomes. To reduce selection bias, inverse probability of treatment weighting methods were performed.

Results

Freedom from atrial fibrillation occurrence at 5 years was 76.5% ± 1.8% and 5.3% ± 1.1% in the ablation and no ablation groups, respectively (P < .001). The ablation group had significantly lower risks for death (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.52-0.93) and thromboembolic events (HR, 0.49; 95% CI, 0.32-0.76) than the no ablation group. Time-varying Cox analysis revealed that the occurrence of stroke after surgery was significantly associated with death (HR, 3.97; 95% CI, 2.36-6.69). In subgroup analyses, the reduction in the composite risk of death and thromboembolic events was observed in all mechanical (n = 829; HR, 0.53; 95% CI, 0.39-0.73), bioprosthetic replacement (n = 239; HR, 0.67; 95% CI, 0.41-1.08), and repair (n = 161; HR, 0.17; 95% CI, 0.06-0.52) subgroups (P for interaction = .47).

Conclusions

Surgical atrial fibrillation ablation during rheumatic mitral valve surgery was associated with a lower risk of long-term mortality and thromboembolic events. Therefore, atrial fibrillation ablation for rheumatic mitral valve disease may be a reasonable option.