Impacts of atrial fibrillation and surgical ablation on rheumatic and degenerative mitral surgeries.

Abstract

To evaluate whether the impacts of atrial fibrillation (AF) ablation differ between rheumatic and degenerative mitral valve (MV) surgeries, given concerns that atrial fibrosis in rheumatic disease may reduce ablation efficacy. Consecutive patients undergoing rheumatic or degenerative MV surgery between 2000 and 2022 were retrospectively examined. The primary end point was death, and the secondary the end point was composite of death, readmission attributable to heart failure, and stroke. In patients with AF, outcomes between ablation and no-ablation groups were compared using inverse probability of treatment weighting to adjust for selection bias. Among 4232 patients (age 56.3 ± 12.7 years; 2357 female), rheumatic and degenerative MV disease were present in 2606 and 1626 patients, respectively, with preoperative AF more frequent in rheumatic than degenerative disease (71.9% vs 34.6%, P < .001). Overall, rates of primary and secondary end points were greatest in AF without ablation, followed by with ablation and those with sinus rhythm (P < .001 for both). In patients with AF, concomitant ablation was associated with reduced adjusted risks of death (hazard ratio, 0.6; 95% CI, 0.49-0.75, P < .001) and composite outcome (hazard ratio, 0.69; 95% CI, 0.57-0.83, P < .001). In subgroup analyses, no significant interactions were found between valve pathology and ablation for death (P = .35) and composite outcomes (P = .87). Combining AF ablation in rheumatic MV surgery was associated with significantly improved long-term clinical outcomes, comparable with those observed in degenerative MV disease.