Utilization and Complications of Catheter Ablation for Atrial Fibrillation in Patients with Prior Mechanical Valves

Background. Background: Catheter ablation (CA) of atrial fibrillation (AF) is a well-established therapy for maintenance of sinus rhythm. Ablation of AF in patients with mechanical valves (MVs) is technically challenging.

Aim: To investigate the utilization and the real-world safety of CA for AF in patients with MVs.

Methods: Using data from the U.S. National Inpatient Sample (NIS), we identified patients with mitral/aortic MVs who required AF ablation in the indexed admission between 2003 and 2015. We compared the trajectory of AF ablation in patients with MVs over more than a decade as well as analyzed and compared the patient’s clinical characteristics, CA intra-operative complications, mortality and length of stay to matched patients without prior valve surgery who have undergone CA for the same indication.

Results: The study included a weighted total of 1898 CA for AF cases in patients with prior MVs patients. Mortality rate (0.2% vs. 0.2%, respectively, p=0.9) and complication rate (8.4% vs 10.4%, respectively, p=0.33) did not differ among patients with and without MVs. Length of stay was longer among patients with prior MVs compared to matched patients (4.0±0.2 vs. 3.3±0.2 days, respectively, p=0.011). Age group of 18-44 years was independently associated with lower rate of complications, while Deyo- Charlson Comorbidity Index 2 or higher, and Rural hospital status were associated with higher rate of complications.

Conclusion: Mortality and complication rates of AF ablation in patients with prior MVs were comparable to matched patients without MVs.