Percutaneous Transvenous Mitral Commissurotomy and Radiofrequency Catheter Ablation in Patients With Mitral Stenosis Initial Experience and Results

Abstract

Background The purpose of this study was to evaluate the short-and long-term results of radiofrequency catheter ablation (RFCA) for the treatment of atrial fibrillation (AF) in patients with mitral stenosis (MS) following percutaneous transvenous mitral commissurotomy (PTMC). Methods and ResultsFour patients (2 males, age 59±6 years) underwent simultaneous PTMC and pulmonary vein (PV) ablation. All patient had AF and MS (2 had persistent AF >1 month, 2 had paroxysmal AF), and the mean duration of AF was 3.4±3.3 years. The mean left atrial dimension was 47±7 mm and the mean ejection fraction was 58±4%. After PTMC, RFCA was performed in all patients (3 underwent PV isolation and 1 had PV focal ablation). The mitral valve area increased from 1.11±0.19 to 1.90±0.20 cm 2 (p<0.01). The frequency of AF episodes was dramatically reduced in the 2 patients with paroxysmal AF, and the 1 with persistent AF maintained sinus rhythm, but 1 patient with persistent AF developed recurrent AF. No complications or cardiac events occurred in any of the patients. Conclusion The combination of RFCA and PTMC was safe and feasible, and may be useful in patients with MS and AF. (Circ J 2005; 69: 1074 -1078

A randomized placebo-controlled trial with amiodarone for persistent atrial fibrillation in rheumatic mitral stenosis after successful balloon mitral valvuloplasty

“…In rheumatic MS after BMV, DCCV combined with amiodarone therapy successfully restored SR and maintained it in 49–81% patients at a mean follow-up of 18–31 months,7, 8 a success rate apparently surpassing that achieved by catheter-based radiofrequency ablation in this particular group of patients 14, 15. Amiodarone is preferred as the antiarrhythmic drug because it has been reported to be more effective than sotalol or class I agents for maintenance of SR in AF 11 and is particularly effective in rheumatic AF patients after mitral valve surgery 6 or BMV 7, 8…”

Hybrid Therapy of Radiofrequency Catheter Ablation and Percutaneous Transvenous Mitral Commissurotomy in Patients With Atrial Fibrillation and Mitral Stenosis

“…Two recent studies have examined the utility of RFCA combined with a PTMC in patients with AF and MS, and have reported the efficacy and safety of the hybrid therapy of a PTMC and RFCA 13,14 . However, the total number of patients was very small.…”

“…Two recent studies have examined the utility of RFCA combined with a PTMC in patients with AF and MS, and have reported the efficacy and safety of the hybrid therapy of a PTMC and RFCA. 13,14 However, the total number of patients was very small. To the best of the authors' knowledge, no study has ever tried to compare the efficacy and safety of the hybrid therapy of a PTMC and RFCA with the conventional therapy of a PTMC and DC.…”

“…[3][4][5] Recently, radiofrequency catheter ablation (RFCA) has been developed as a curative therapy in patients with drug-resistant AF. [6][7][8][9][10] Several studies have assessed the efficacy of a maze procedure combined with mitral valve surgery for the rhythm control in patients with AF and MS. 11,12 Few studies, however, have examined the efficacy of RFCA combined with a PTMC in a relatively small number of patients with drug-resistant AF and MS. 13,14 Accordingly, the purpose of this study was to clarify the efficacy and safety in those patients.…”

Prognostic Predictors of Sinus Rhythm Control by Amiodarone and Electrical Cardioversion in Patients Undergoing Percutaneous Transluminal Mitral Valvuloplasty for Rheumatic Atrial Fibrillation

“…Catheter ablation is seldom performed in rheumatic AF patients, 23 but in those studies that have used it, the success rate was limited. 11,12 The intra-operative radiofrequency maze procedure 18 is an option only for patients undergoing concomitant open-heart surgery for MV replacement. Thus, the strategy we studied here represents a feasible alternative treatment option in select patients after PTMV and may be justified in patients subject to the possible risk of sideeffects from long-term amidarone use, because AF can be converted to SR and the risk of thromboembolism can be reduced.…”