Short-term and mid-term effects of radiofrequency ablation in mitral valve surgery in patients with different left atrial sizes

Yao, Mengfei; Ren, Chao; Zhang, Lin; Li, Liang-gang; Jiang, Shengli

doi:10.21037/jtd-20-2953

Cited by 5 publications

(5 citation statements)

References 13 publications

(13 reference statements)

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“…As discussed earlier, this bias might be due to the variation in surgical methodology. Mitral valve surgery was safe and effective in patients in restoring SR by using ablation to treat AF [24–26] . There is no doubt that surgical ablation can successfully block AF conduction to maintain the normal SR, as reported in previous reviews.…”

Section: Discussionsupporting

confidence: 54%

“…Mitral valve surgery was safe and effective in patients in restoring SR by using ablation to treat AF. [ 24 – 26 ] There is no doubt that surgical ablation can successfully block AF conduction to maintain the normal SR, as reported in previous reviews. Phan et al [ 27 ] and McClure et al [ 6 ] evaluated the efficacy of promoting SR in patients who underwent cardiac surgery combined with surgical ablation.…”

Section: Discussionmentioning

confidence: 76%

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Efficiency and safety of ablation procedure for the treatment of atrial fibrillation in valve surgery

Wang¹,

Wu²,

Zhang³

et al. 2021

Medicine

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Background: Atrial fibrillation is the main complication of patients who suffer from valvular heart disease (VHD), which may lead to an increased susceptibility to ventricular tachycardia, atrial dysfunction, heart failure, and stroke. Therefore, seeking a safe and effective therapy is crucial in prolonging the lives of patients with VHD and improving their quality of life. Methods: Our target database included PubMed, Web of Science, Embase, and Cochrane Library, from which published articles were retrieved from inception to June 2020. We retrieved all randomized controlled trials (RCTs) that compared patients undergoing valve surgery with (VSA) or without ablation (VS) procedure. Studies to be included were screened and data extraction was performed independently by 2 investigators. The Cochrane risk-of-bias table was used to evaluate the methodological quality of the included RCTs. The mean difference (MD) with 95% confidence interval (CI) and relative risk (RR) ratio was calculated to analyze the data. Heterogeneity was evaluated using I 2 and chi-square tests. Egger test and the trim and fill analysis were used to further determine publication bias. Results: Fourteen RCTs that included 1376 patients were eventually selected for this meta-analysis. Surgical ablation was found to be effective in restoring sinus rhythm in valvular surgery patients at discharge (RR 2.91, 95% CI [1.17, 7.20], I 2 97%, P = .02), 3 to 6 months (RR 2.85, 95% CI [2.27, 3.58], I 2 49%, P < .00001), 12 months, and more than 1 year after surgery (RR 3.54, 95% CI [2.78, 4.51], I 2 27%, P < .00001). All-cause mortality (RR 0.98, 95% CI [0.64, 1.51], I 2 0%, P = .94) and stroke (RR 1.29, 95% CI [0.70, 2.39], I 2 0%, P = .57) were similar in the VSA and VS groups. Compared with VS, VSA prolonged cardiopulmonary bypass time (MD 30.44, 95% CI [17.55, 43.33], I 2 88%, P < .00001) and aortic cross-clamping time (MD 19.57, 95% CI [11.10, 28.03], I 2 89%, P < .00001). No significant differences were found between groups with respect to the risk of bleeding (RR 0.64, 95% CI [0.37, 1.12], I 2 0%, P = .12), heart failure (RR 1.11, 95% CI [0.63, 1.93], I 2 0%, P = .72), and low cardiac output syndrome (RR 1.41, 95% CI [0.57, 3.46], I 2 18%, P = .46). However, the demand for implantation of a permanent pacemaker was significantly higher in the VSA group (RR 1.84, 95% CI [1.15, 2.95], I ...

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 76%

Efficiency and safety of ablation procedure for the treatment of atrial fibrillation in valve surgery

Wang¹,

Wu²,

Zhang³

et al. 2021

Medicine

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“…Female patients with a LAD ≥47 mm and male patients with a LAD ≥53 mm are considered to be severely enlarged ( 11 ), and thus, a LAD >50 mm is considered severe enlargement. Our previous report ( 12 ) showed that conventional thoracotomy combined with surgical ablation of AF for LAD <45 mm provides good results. Also, the early postoperative and 2-year AF conversion rates can be as high as 91% and 84% respectively, which were 84% and 70% respectively for LAD >45 mm, and these differences were statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Clinical effect of total thoracoscopic mitral valve surgery combined with atrial fibrillation radiofrequency ablation in patients with different left atrium diameter—a single center prospective observational cohort study

Yao¹,

Zhang²,

Li³

et al. 2022

J Thorac Dis

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Background Mitral valve surgery combined with atrial fibrillation (AF) radiofrequency ablation (AFRA) is recommended as the first-line strategy for valvular disease-related AF. There are relatively few reports on the effect of AFRA combined with total thoracoscopic mitral valve surgery. This article aimed to analyze the clinical data and prognostic outcomes of patients with diverse left atrium diameter (LAD) (>50 or ≤50 mm) who underwent total thoracoscopic mitral valve surgery combined with AFRA. Methods We conducted a prospective analysis of patients who underwent AFRA from January 2021 to June 2022 in the Department of Cardiovascular Surgery at the Chinese PLA General Hospital. The inclusion criteria were: (I) aged 40–70 years; (II) diagnosed with valvular heart disease and concomitant long-term persistent AF (>1 year); (III) patients who underwent total thoracoscopic mitral valve surgery; (IV) with a left ventricular end-diastolic diameter of ≤70 mm; (V) with a LAD ≤65 mm; and (VI) left ventricular ejection fraction (LVEF) ≥50%. The included patients were assigned to group A and B depend up on the LAD. All patients were followed up at 3 and 6 months timepoints postoperatively. The prime endpoint was the recovery rate of sinus rhythm. Results There were 24 cases in group A (LAD >50 mm) and 16 cases in group B (LAD ≤50 mm). The two groups exhibited no statistical differences in terms of age, gender proportion, preoperative comorbidities, AF duration, preoperative heart function, and type of valve disease (P>0.05). The LAD, pulmonary artery pressure, and left ventricular diameter of group A were significantly greater than those of group B (P<0.05). There were no new cerebrovascular incidents during the perioperative and follow-up periods. The sinus rhythm conversion rates in group A after surgery and at 6 months were 75% and 66.7%, respectively; meanwhile, both of these values were 87.5% in group B, and the difference between the groups was statistically significant (P<0.05). Conclusions Total thoracoscopic mitral valve surgery with AFRA is more effective in maintaining sinus rhythm in patients with LAD ≤50 mm than in those with LAD >50 mm without increased risk of adverse events. Further studies are warranted to validate our findings.

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“…Atrial fibrillation is the most common sustained arrhythmia that increases with age and presents with a wide spectrum of symptoms and severity, including reentry theory and focal agitation [17,18]. Despite shorter ablation times, faster balloon cooling, and longer thawing times, ablation of atrial fibrillation with a second-generation cryoballoon is associated with higher success rates of pulmonary venous dissociation, acute and long-term PV isolation rates are high, AE rates are similar, and atrial fibrillation is absent [19].…”

Section: Discussionmentioning

confidence: 99%

Improved prognostic value of recurrence for atrial fibrillation patients after cryoablation by non-linear survival models

Li,

Liao,

Chen

et al. 2023

Preprint

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Background: Atrial fibrillation (AF) is a common cardiac arrhythmia that affects millions of people worldwide. We aim to investigate how to improve prognostic value of recurrence for atrial fibrillation patients after cryoablation by non-linear survival models. Methods: In this study, we retrospectively reviewed data from 1023 patients who underwent cryoablation surgery for AF at Fujian Provincial Hospital (FPH). We generated radiomics signatures (RSI) and a clinical signature (CLI) using a non-linear survival model by repeated 10-fold cross-validation. The comprehensive risk score (TCRS) was obtained by linearly weighting the multivariate Cox proportional risk model. Results: The combination of RSI and CLI indicators had a significantly higher area under the curve (AUC) in the ROC curve of the training set (AUC=0.955) compared to the AUC of a single indicator CLI (AUC=0.862). The TCRS showed better prognostic performance compared to the traditional Lasso-Cox models, with AUC of 0.955 vs 0.664. The accuracy of the model was further confirmed by the C-indices of RSI (C-index: 0.8894; 95%CI: 0.8166-0.9621), CLI (C-index: 0.8431; 95%CI: 0.7466-0.9395), and TCRS (C-index: 0.9072; 95%CI: 0.8281-0.9864) in validation set 2. Conclusions: Under a nonlinear survival model, TCRS which combines RSI and CLI indicators has potential as a promising prognostic tool for post-cryoablation AF patients.

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Short-term and mid-term effects of radiofrequency ablation in mitral valve surgery in patients with different left atrial sizes

Abstract: Background: To evaluate the efficacy of atrial fibrillation radiofrequency ablation (AFRA) in patients with chronic valvular atrial fibrillation (AF) with different left atrial sizes [left atrial diameter (LAD) >45 or ≤45 mm].

Cited by 5 publications

References 13 publications

Efficiency and safety of ablation procedure for the treatment of atrial fibrillation in valve surgery

Efficiency and safety of ablation procedure for the treatment of atrial fibrillation in valve surgery

Clinical effect of total thoracoscopic mitral valve surgery combined with atrial fibrillation radiofrequency ablation in patients with different left atrium diameter—a single center prospective observational cohort study

Improved prognostic value of recurrence for atrial fibrillation patients after cryoablation by non-linear survival models

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