Ventricular arrhythmia ablation in patients with mitral valve surgery

Abstract

We have read with great interest the study entitled, "Characteristics and outcomes of ventricular tachycardia and premature ventricular contractions ablation in patients with prior mitral valve surgery" by Khalil et al. 1 This study demonstrated that ventricular arrhythmia (VA) ablation can be performed safely and effectively in patients with a history of previous mitral valve surgery (MVS). We wanted to mention some methodological and clinical features of this article that can guide future studies on this subject.In patients with structural heart disease, VA ablation is recommended if indicated. 2,3 Difficulties for left ventricular access and other structural alterations in patients with valve surgery may complicate the ablation of VAs. Therefore, different methods can be used for VA ablations in these groups of patients. 4,5 This study has a heterogeneous population in terms of etiology and patient characteristics. Whether mitral valve disease is primary or secondary, the presence of ischemic heart disease may also provide preliminary information about the characteristics and causes of VAs. In this study, it would be appropriate to compare the characteristics of VAs and ablation in patients with primary and secondary mitral valve disease and in patients with and without ischemic heart disease. Although not specified, the lack of preprocedural magnetic resonance imaging (MRI) data can be considered one of the limitations of the study. The fact that most VAs in MVS patients were not found to be associated with the perimitral region indicates that patient characteristics, echocardiography, and cardiac MRI findings should be evaluated in detail before ablation in these patients.