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Hybrid Therapy of Radiofrequency Catheter Ablation and Percutaneous Transvenous Mitral Commissurotomy in Patients With Atrial Fibrillation and Mitral Stenosis
Article first published online: 8 OCT 2009
© 2009 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 21, Issue 3, pages 284–289, March 2010
How to Cite
MACHINO, T., TADA, H., SEKIGUCHI, Y., TANAKA, Y., NAITO, S., YAMASAKI, H., ARIMOTO, T., IGARASHI, M., KUROKI, K., SEO, Y., WATANABE, S., HOSHIZAKI, H., OSHIMA, S., TANIGUCHI, K. and AONUMA, K. (2010), Hybrid Therapy of Radiofrequency Catheter Ablation and Percutaneous Transvenous Mitral Commissurotomy in Patients With Atrial Fibrillation and Mitral Stenosis. Journal of Cardiovascular Electrophysiology, 21: 284–289. doi: 10.1111/j.1540-8167.2009.01625.x
- Issue published online: 22 FEB 2010
- Article first published online: 8 OCT 2009
- Manuscript received 16 May 2009; Revised manuscript received 23 August 2009; Accepted for publication 25 August 2009.
- atrial fibrillation (AF);
- catheter ablation;
- mitral stenosis (MS);
- percutaneous transvenous mitral commissurotomy (PTMC);
- pulmonary vein
AF Ablation and PTMC. Background: The rhythm control of atrial fibrillation (AF) associated with mitral stenosis (MS) is often difficult using antiarrhythmic drugs (AADs), even after a percutaneous transvenous mitral commissurotomy (PTMC). Few studies have examined the efficacy and safety of simultaneously performing radiofrequency catheter ablation (RFCA) and a PTMC in patients with MS and AF.
Methods: Twenty consecutive patients with drug-resistant AF and rheumatic MS underwent RFCA combined with a PTMC (n = 10; persistent AF-8, long-lasting [>1 year] persistent AF-2; RFCA group) or transthoracic direct cardioversion (DC) following a PTMC (n = 10; persistent AF-7, long-lasting persistent AF-3; DC group). In all patients, the mitral valve morphology was amenable to a PTMC, and more than 2 AADs had been ineffective in maintaining sinus rhythm (SR). In the RFCA group, a segmental pulmonary vein isolation (PVI) was performed in the initial 5 patients, and an extensive PVI was performed in the remaining 5.
Results: During a mean follow-up period of 4.0 ± 2.7 years, 8 patients (80%) in the RFCA group were maintained in SR, as compared to 1 (10%) in the DC group (hazard ratio, 0.16; 95% confidence interval, 0.03 to 0.75; P = 0.008 by the log-rank test). The prevalence of the concomitant use of class I and/or class III AADs was comparable between the 2 groups (P = 0.70). No complications occurred during the procedure or follow-up period in either group.
Conclusions: The hybrid therapy using RFCA and a PTMC was safe and feasible, and significantly improved the AF free survival rate compared to DC following a PTMC. (J Cardiovasc Electrophysiol, Vol. 21, pp. 284–289, March 2010)