Ablation with Valve Repair Has Advantages

About two-thirds of surgeons performing mitral valve surgery on patients with atrial fibrillation (AF) do ablation procedures at the same time. There are no official guidelines on when to do both. Trying to provide more information to guide such decisions, a US-Canada team randomized a group of these patients to either valve repair alone, or valve repair with ablation. The dual approach seems better.

About two-thirds of surgeons performing mitral valve surgery on patients with atrial fibrillation (AF) do ablation procedures at the same time. There are no official guidelines on when to do both. Trying to provide more information to guide such decisions, a US-Canada team randomized a group of these patients to either valve repair alone, or valve repair with ablation.

The team found there are pro’s and con’s to doing both approaches in caring for patients with leaky mitral valves and AF.

Of patients who received ablation and mitral valve surgery, 63% had no AF at 6 months, while only 29% of patients who received the valve surgery alone had no AF at that time point. The same was true at 12 months.

But the patients who had both procedures were more 2.5 times more likely to need a pacemaker within a year after the surgery.

The research involved 260 patients in the Cardiothoracic Surgical Trials Network, a clinical research affiliation of 20 US and Canadian hospitals. It was reported March 16 at the American College of Cardiology meeting in San Diego, CA.

All study participants had AF and were getting mitral valve surgery. Lead researcher Marc Gillinov, MD, of the Cleveland Clinic said the reason more patients in the group that did not also get ablation needed pacemakers was unknown.

On balance, he said, performing both procedures seems better.

“I think what this shows is that, in the mitral valve surgery patients who have persistent atrial fibrillation, you will achieve better rhythm control by performing ablation, without any increase in mortality or other adverse cardiac events.”

Patients in the two groups had no significant difference in death rates, adverse cardiac events or hospitalization, but many who did not have ablation said they still had daily AF episodes.

Two ablation techniques were used. The researchers found no significant differences in outcomes. In one technique the surgeon destroys a small area of heart tissue and in the other, he or she makes a complex series of heart lesions to correct the abnormal electrical impulses. A larger study might be necessary to validate that finding, the team said.

The study was also published online in the New England Journal of Medicine.