Preventive atrial fibrillation ablation in patients with mitral valve lesion and left atrium enlargement: 3-month follow-up results

Aim. Persistence or appearance of atrial fibrillation (AF) after mitral valve surgery significantly reduces the number of excellent and good results in the long-term period. AF leads to heart failure and pulmonary hypertension and increases the risk of thromboembolic events and stroke. Drug strategies for prevention of new-onset AF in the postoperative period are well developed, while invasive methods are still under development and clinical trials. This study aims to evaluate the safety and efficacy of surgical prevention of atrial fibrillation in patients with left atrium enlargement and mitral valve (MV) lesion at 3-month follow-up. Methods. Forty patients operated in our clinic over a period of 2015-2017 were included in the study. All patients had MV lesion and left atrial dilatation greater than 60 mm. All patients had a sinus rhythm at the time of the operation and no documented AF in the history. The mean age of the patients was 48.9±10.1 (23-69 years). All patients had indications for mitral valve surgery and were randomized into two groups. The first group included patients who underwent a concomitant preventive ablation procedure (n = 20). The second group included patients with isolated MV surgery (n = 20). Complications and heart rhythm were evaluated within 3 months after surgery. Results. Patients who underwent preventive ablation did not differ significantly in the number of complications as compared with the control within 3 months after the surgery. In the group of patients with preventive ablation, a higher freedom from AF in comparison with the group of patients with isolated MV surgery was observed: 95 vs. 40%, respectively. Conclusion. Preventive atrial fibrillation ablation in patients with mitral valve lesion and left atrium enlargement reduces the risk of atrial fibrillation by 1.6 times within 3-month follow-up.