Acute and long-term success of left atrial anterior line and mitral isthmus line ablation in patients after mitral valve surgery
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Acute and long-term success of left atrial anterior line and mitral isthmus line ablation in patients after mitral valve surgery. / Bertels, Jana; Rottner, Laura; Heeger, Christian-Hendrik; Maurer, Tilman; Reissmann, Bruno; Ouyang, Feifan; Mathew, Shibu; Wohlmuth, Peter; Schlüter, Michael; Kuck, Karl-Heinz; Metzner, Andreas; Lemeš, Christine.
in: PACE, Jahrgang 45, Nr. 9, 09.2022, S. 1024-1031.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Acute and long-term success of left atrial anterior line and mitral isthmus line ablation in patients after mitral valve surgery
AU - Bertels, Jana
AU - Rottner, Laura
AU - Heeger, Christian-Hendrik
AU - Maurer, Tilman
AU - Reissmann, Bruno
AU - Ouyang, Feifan
AU - Mathew, Shibu
AU - Wohlmuth, Peter
AU - Schlüter, Michael
AU - Kuck, Karl-Heinz
AU - Metzner, Andreas
AU - Lemeš, Christine
N1 - © 2022 Wiley Periodicals LLC.
PY - 2022/9
Y1 - 2022/9
N2 - BACKGROUND: Perimitral flutter and atrial fibrillation may occur in patients with prior surgical mitral valve (MV) repair or replacement and can be challenging for percutaneous catheter ablation. This study sought to determine the feasibility, acute success and durability of catheter ablation of atrial fibrillation or atrial tachycardia by way of a mitral isthmus line (MIL) or an anterior line (AL).METHODS: A total of 81 patients (49 males, mean age 62±11 years) with prior MV replacement (n = 30) or reconstruction (n = 51) underwent creation of a MIL (34) and/or an AL (72).RESULTS: Acute bidirectional block of the MIL was successfully achieved in 24/34 cases and of the AL in 64/72 patients. Patients of the control group without prior MV surgery were matched 1:1 with the valve group. In the AL control subgroup, acute bidirectional block was achieved in 65/72 patients. Acute blockage in the MIL control subgroup could be achieved in 31/34 patients. The MIL valve subgroup showed the worst results in terms of durability, whereas a similar trend emerged in the control group and the AL valve subgroup (probability of failure in MIL valve subgroup 2.224 vs. MIL control subgroup 0.605 [Hazard Ratio (HR) = 0.27, 95% confidence interval (CI), 0.11-0.65), P = .004]; probability of failure in AL valve subgroup 0.844 vs. AL control subgroup 1.03 [HR = 1.22 (95% CI, 0.66-2.26), P = .523]).CONCLUSIONS: Percutaneous creation of MIL and AL is feasible and safe in patients with prior MV replacement/repair and associated with moderate acute and long-term success rates to achieve bidirectional block.
AB - BACKGROUND: Perimitral flutter and atrial fibrillation may occur in patients with prior surgical mitral valve (MV) repair or replacement and can be challenging for percutaneous catheter ablation. This study sought to determine the feasibility, acute success and durability of catheter ablation of atrial fibrillation or atrial tachycardia by way of a mitral isthmus line (MIL) or an anterior line (AL).METHODS: A total of 81 patients (49 males, mean age 62±11 years) with prior MV replacement (n = 30) or reconstruction (n = 51) underwent creation of a MIL (34) and/or an AL (72).RESULTS: Acute bidirectional block of the MIL was successfully achieved in 24/34 cases and of the AL in 64/72 patients. Patients of the control group without prior MV surgery were matched 1:1 with the valve group. In the AL control subgroup, acute bidirectional block was achieved in 65/72 patients. Acute blockage in the MIL control subgroup could be achieved in 31/34 patients. The MIL valve subgroup showed the worst results in terms of durability, whereas a similar trend emerged in the control group and the AL valve subgroup (probability of failure in MIL valve subgroup 2.224 vs. MIL control subgroup 0.605 [Hazard Ratio (HR) = 0.27, 95% confidence interval (CI), 0.11-0.65), P = .004]; probability of failure in AL valve subgroup 0.844 vs. AL control subgroup 1.03 [HR = 1.22 (95% CI, 0.66-2.26), P = .523]).CONCLUSIONS: Percutaneous creation of MIL and AL is feasible and safe in patients with prior MV replacement/repair and associated with moderate acute and long-term success rates to achieve bidirectional block.
KW - Aged
KW - Atrial Fibrillation/surgery
KW - Catheter Ablation/methods
KW - Heart Atria
KW - Humans
KW - Male
KW - Middle Aged
KW - Mitral Valve/surgery
KW - Tachycardia, Supraventricular
KW - Treatment Outcome
U2 - 10.1111/pace.14564
DO - 10.1111/pace.14564
M3 - SCORING: Journal article
C2 - 35822917
VL - 45
SP - 1024
EP - 1031
JO - PACE
JF - PACE
SN - 0147-8389
IS - 9
ER -