Efficiency of radiofrequency ablation for surgical treatment of chronic atrial fibrillation in rheumatic valvular disease

Abstract

Background: It remains unclear whether concomitant radiofrequency ablation procedure in valvular surgery could offer additional benefits to patients with rheumatic valvular disease. We designed a prospective and randomized control study to evaluate the efficacy of surgical radiofrequency ablation in patients with rheumatic heart disease.

Methods: From June 2008 to July 2011, 210 patients with chronic atrial fibrillation and rheumatic heart disease were randomized: (1) control group, patients underwent only valve replacement followed by amiodarone for rhythm control, (2) left atrial group (LA group), patients underwent valve replacement and left atrial mono-polar radiofrequency ablation, (3) bi-atrial group (BA group), patients underwent valve replacement and bi-atrial mono-polar radiofrequency ablation. The primary endpoints included: cardiac death, stroke, and recurrent AF after discharge.

Results: There was no perioperative death. One patient died 4 months after MVR in BA group. In univariate Cox analysis, the two ablation groups were associated with less AF (BA group vs control group: P<0.001; LA group vs control group: P<0.001) as well as atrial tachycardia arrhythmia (AF/AT/AFL) recurrent (BA group vs control group: P<0.001; LA group vs control group: P=0.02). The comparison between BA and LA groups revealed no differences in terms of AF (P=0.06) or AF/AT/AFL (P=0.09). Atrial transport function restoration rate 12 months after operation was 31.4% in LA group, 32.9% in BA group, and 8.6% in control group respectively (P<0.01).

Conclusions: Radiofrequency ablation concurring with valvular surgery can bring a higher sinus rhythm restoration rate when compared with medical anti-arrhythmic drug therapy in low-medium risk rheumatic heart disease. The trial was registered on Clinicaltrials.gov (registry number NCT01013688).

Keywords: Ablation; Atrial fibrillation; Rheumatic heart valve disease.