Substrate characteristics and ablation outcome of left atrial tachycardia in rheumatic mitral valve disease

Abstract

Left atrial AT can occur in RHD patients postmitral valve replacement. Catheter ablation is feasible with high acute success rate. The incidence of late development atrial fibrillation is considerable after successful ablation.

Catheter ablation of atrial tachycardias after mitral valve surgery: A systematic review and meta‐analysis

“…The high acute success in suppressing ATs by CA was, however, associated with a great heterogeneity among studies. With the exception of two studies, 17,20 studies published after 2010 were associated with a greater acute success compared to older studies with concomitant significant abatement of heterogeneity. These data F I G U R E 4 Atrial fibrillation occurrence at follow-up after catheter ablation of complex atrial arrhythmias after mitral valve surgery.…”

“…Other main features of clinical studies are reported in Table 1. Of note, demographic characteristics (including age and sex) were available in 218 patients (96%) 14–20,22–27 . Left ventricular ejection fraction (LVEF) was available in 183 patients (81%) from eight studies (57%) 14–18,22,23,27 and left atrial anteroposterior diameter was available in 156 patients (69%) 15–19,22,23,26,27 …”

“…[14][15][16][17][18][19][20][22][23][24][25][26][27] Left ventricular ejection fraction (LVEF) was available in 183 patients (81%) from eight studies (57%) [14][15][16][17][18]22,23,27 and left atrial anteroposterior diameter was available in 156 patients (69%). [15][16][17][18][19]22,23,26,27 All patients underwent MVS; however, the type of MVS was not clearly reported in three studies (21%). 14,20,21 Briefly, 67% and 33% of patients underwent MV replacements with biological or mechanical prostheses and mitral valvuloplasty, respectively.…”

“…ATs suppression was obtained in 212 patients leading to an overall pooled estimate of acute procedural success equal to 95% (95% CI: 87 to 100, p < .0001; I 2 = 53%, p = .010) ( Figure 2). Subgroup analysis revealed a significant improvement in the procedural success (heterogeneity between subgroups: p = .027) among the 10 studies [14][15][16][17][18][19][20][22][23][24] published after the year 2010 (pooled estimate of the proportion of 97%; 95% CI: 92%-100%; I 2 = 39.7%; p = .09) when compared to the four studies 21,[25][26][27] published before 2010 (pooled estimate of proportion 81%; 95% CI: 56%-98%; I 2 = 17%; p = .31). The formal test for publication bias did not achieve statistical significance (p = .071).…”

“…Considering that 3D mapping systems were used in all studies, the improvement could be related to optimization of the use of these systems which require specific know-how in their handling. In the above-mentioned studies, 17,20 the lower success rate could be related to empirical ablation with no definition of the arrhythmogenic substrate in one 20 and too complex atrial substrate associated with rheumatic heart disease in the other. 17…”