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Cited 9 time in webofscience Cited 9 time in scopus
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Clinical characteristics and rhythm outcome of catheter ablation of hemodynamically corrected valvular atrial fibrillation

Authors
Kim, Jung OkShim, JaeminLee, Seung-HyunYu, Hee TaeKim, Tae-HoonUhm, Jae-SunChoi, Jong-IlChoi, Jae YoungLee, Moon-HyungKim, Young-HoonChang, Byung-ChulPak, Hui-Nam
Issue Date
Jun-2019
Publisher
ELSEVIER SCIENCE BV
Keywords
Valvular atrial fibrillation; Catheter ablation; Maze operation
Citation
JOURNAL OF CARDIOLOGY, v.73, no.6, pp 488 - 496
Pages
9
Indexed
SCIE
SCOPUS
Journal Title
JOURNAL OF CARDIOLOGY
Volume
73
Number
6
Start Page
488
End Page
496
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/1993
DOI
10.1016/j.jjcc.2018.10.014
ISSN
0914-5087
1876-4738
Abstract
Background: Although the hemodynamic burden and structural substrate contribute to valvular atrial fibrillation (VAF) mechanisms, the role of catheter ablation has rarely been reported. We investigated the clinical characteristics, mapping findings, and long-term rhythm outcomes after catheter ablation of hemodynamically corrected VAF. Methods: We compared 77 patients with VAF (46.8% male, 52.7 +/- 8.8 years old, 46.8% paroxysmal AF, 24.7% with maze procedures) and 2244 patients with non-VAF (NVAF) who underwent catheter ablation. Among the VAF patients, 44 (57.1%) had mechanical valve AF (MV-AF) and 33 (42.9%) underwent a prior mitral valvuloplasty (MVP-AF). We analyzed the catheter ablation rhythm outcomes for MV-AF and MVP-AF. Results: The left atrial (LA) diameter was greater (p < 0.001), LA voltage lower (p < 0.001), and procedure-related complication rate higher (mainly sinus node dysfunction, p = 0.004) for VAF than NVAF. During 70.2 +/- 1.8 months of follow-up, the rhythm outcome of VAF did not significantly differ from that of NVAF after catheter ablation (log rank p = 0.399), even after excluding patients with maze procedures (log rank p = 0.629). The clinical recurrence rates did not differ between the MV-AF and MVP-AF groups (log rank p = 0.244), or between patients with prior maze procedures and those without (log rank p = 0.651). The main conduction recovery sites of previous maze procedures were the perimitral (84.2%) and cavotricuspid isthmus (84.2%) areas, and recurrence mechanisms were macroreentry (63.2%) and focal/microreentry (26.3%) at scar border zones. Conclusions: Although hemodynamically corrected VAF was associated with advanced LA remodeling, the rhythm outcome did not significantly differ from that of NVAF after catheter ablation. (C) 2018 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Kim, Young Hoon
Anam Hospital (Department of Cardiology, Anam Hospital)
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