AF ablation complications similar in patients with, without mechanical valves
Catheter ablation for atrial fibrillation in patients with mechanical valve prostheses conferred similar risk for periprocedural complications and mortality as in patients without prosthetic valves, data show.
There is limited evidence for safety of catheter ablation for AF in patients with mechanical prosthetic valves, with studies based on relatively small cohorts of patients from high-volume ablation centers, Guy Rozen, MD, MHA, of the cardiology division of Hillel Yaffe Medical Center in Haifa, Israel, and colleagues wrote in the Journal of Cardiovascular Electrophysiology.
“In patients with mechanical prosthetic valve, there is a general conception among cardiologists of a relatively low efficacy and excess periprocedural risk for AF ablations,” Rozen and colleagues wrote in the study background. “This perception can be attributed to the patients’ clinical characteristics, presence of congestive heart failure, big atria, high risk for stroke and additional challenges to the ablation procedure, like chronic warfarin therapy and risk for entrapment of mapping or ablation catheters between the leaflets of the mechanical prosthetic valve.”
Rozen and colleagues analyzed 1,898 AF ablations in patients with mechanical prosthetic valves from 2003 to 2015, using the U.S. National Inpatient Sample database. Researchers assessed the incidence of procedural complications, mortality and length of stay compared with a propensity-matched cohort without mechanical prosthetic valves. The median age of patients was 67 years and 53% were men.
Despite the increasing age and uptrend in the prevalence of individual comorbidities and Charlson Comorbidity Index (CCI) from 2003 to 2015, risk for periprocedural complications and mortality did not change, the researchers wrote.
The periprocedural complication rate was similar among patients with mechanical prosthetic valves and matched patients without mechanical prosthetic valves (8.4% vs. 10.4%; P = .33), as was the rate of in-hospital mortality (0.2% vs. 0.2%; P = .9).
Length of stay was higher among patients who had mechanical prosthetic valves before the procedure compared with controls (mean, 4 days vs. 3.3 days; P = .011).
“This study confirms, in a real-world setting, that catheter ablation is a safe therapeutic alternative in patients with mechanical prosthetic valves, suffering from AF, compared to patients without mechanical prosthetic valves,” the researchers wrote. “The presence of a mechanical prosthetic valve is not associated with excess periprocedural risks and should not preclude consideration of catheter ablation in this patient population.”
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