Long-term outcomes of radiofrequency catheter ablation for atrial fibrillation in rheumatic heart disease patients with mild mitral stenosis

Purpose: To assess efficacy of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in rheumatic heart disease (RHD) patients with mild mitral stenosis (MS).

Methods: This retrospective cohort study included 62 consecutive RHD patients with mild MS and AF and 124 AF patients without RHD with matched age, gender, AF types as control. Procedure endpoints were defined as circumferential pulmonary vein ablation (CPVA) for paroxysmal AF, CPVA plus bidirectional block of lines, and disappearance of complex fractionated atrial electrograms for non-paroxysmal patients in both groups.

Results: Cumulative success rate during the total follow-up (RHD, 23-140 months; control, 24-140 months) was lower in RHD group than control (32.3 vs. 56.5%, log-rank P = 0.006). In RHD patients, the success rate was higher in paroxysmal AF patients than non-paroxysmal AF patients during the mid-term follow-up (55.0 vs. 26.2%, log-rank P = 0.041), and was similar between the two AF types during the total follow-up (45.0 vs. 26.2%, log-rank P = 0.130). Patients without mitral regurgitation (MR) or with mild MR had a higher success rate than patients with moderate MR during the total follow-up in both groups (45.0 vs. 9.1%, log-rank P = 0.014 in RHD group; 64.5 vs. 43.8%, log-rank P = 0.001 in control group).

Conclusions: The long-term outcome of RFCA for AF in RHD patients with mild MS was mediocre and worse than that for AF patients without RHD. The severity of MR was associated with RFCA outcome in both groups. In RHD patients with mild MS, a better prognosis of paroxysmal AF than non-paroxysmal AF was observed initially but turned similar over time.