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Published on: February 26, 2013
Surgical Ablation for Atrial Fibrillation During Mitral Valve Surgery: A Systematic Review and Meta-Analysis of
Marco Gemelli1, Michele Gallo2, Mariangela Addonizio1
1Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiac Surgery Unit, University of Padua, Padua, Italy.
Abstract:
Although surgical ablation has been shown to produce excellent outcomes at follow-up for patients with atrial fibrillation who underwent mitral valve replacement/repair (MVR), this procedure is not commonly performed. Our objective was to conduct a systematic review and meta-analysis to evaluate the outcomes of concomitant surgical ablation during MVR. Three databases were systematically reviewed for randomized clinical trials published by August 2022. The primary outcome was sinus rhythm (SR) at 12 months. Secondary outcomes included SR at discharge and 6 months, all-cause mortality, permanent pacemaker implantation, and stroke and thromboembolic events. A random-effects meta-analysis was performed, calculating odds ratios (ORs) for each outcome. Thirteen studies were included, involving 1,089 patients comparing patients who underwent either isolated MVR ("MVR-only") or concomitant surgical ablation during MVR ("MVR+Ablation"). The odds of SR were significantly higher in the MVR+Ablation group at discharge (OR 9.62, 95% confidence interval [CI] 4.87 to 19.02, I2 = 55%), at 6-month follow-up (OR 7.21, 95% CI 4.30 to 12.11, I2 = 34%), and at 1-year follow-up (OR 8.41, 95% CI 5.14 to 13.77, I2 = 48%). All-cause mortality was not different in the groups, as were stroke and thromboembolic events, whereas the odds of permanent pacemaker implantation were slightly higher in the MVR+Ablation group (OR 1.87, 95% CI 1.11 to 3.17, I2 = 0%). Concomitant surgical ablation during MVR showed excellent outcomes at short-term follow-up, despite a slightly higher rate of permanent pacemaker implantation. Further studies with longer follow-ups are needed to assess if the SR is maintained over the years.
Insights
Concomitant surgical ablation during mitral valve replacement/repair (MVR) significantly improves sinus rhythm (SR) outcomes at short-term follow-up. While effective for maintaining SR, this combined procedure shows a slightly increased need for permanent pacemaker implantation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
Background:
- Atrial fibrillation (AF) management alongside mitral valve disease presents a clinical challenge.
- Surgical ablation during mitral valve replacement/repair (MVR) is underutilized despite potential benefits for AF patients.
Approach:
- A systematic review and meta-analysis of randomized clinical trials (RCTs) published by August 2022 was conducted.
- Included 13 studies with 1,089 patients comparing isolated MVR versus MVR with concomitant surgical ablation (MVR+Ablation).
- Primary outcome: sinus rhythm (SR) at 12 months. Secondary outcomes: SR at discharge and 6 months, mortality, pacemaker implantation, and thromboembolic events.
Key Points:
- MVR+Ablation significantly increased the odds of achieving SR at discharge (OR 9.62), 6 months (OR 7.21), and 12 months (OR 8.41) compared to MVR-only.
- No significant differences were observed in all-cause mortality or stroke/thromboembolic events between the groups.
- A slightly higher odds of permanent pacemaker implantation were noted in the MVR+Ablation group (OR 1.87).
Conclusions:
- Concomitant surgical ablation during MVR demonstrates excellent short-term efficacy in restoring and maintaining sinus rhythm.
- The procedure is associated with a marginally increased risk of permanent pacemaker implantation.
- Further research with extended follow-up periods is warranted to confirm long-term SR maintenance and overall outcomes.
