Mid-term results of endoscopic mitral valve repair in combination with endocardial or epicardial ablation.

Objective: Concomitant ablative therapy for atrial fibrillation can be effective at converting patients to normal sinus rhythm and at maintaining a regular rhythm for at least 5 years. We provide herein a comparison of an endocardial approach using Cryoablation with an epicardial approach using a suction-based RF ablation technology.

Methods: Between February 2004 and January 2009, 325 patients underwent an endoscopic mitral valve repair. Of those patients, 112 (35%) had a history of atrial fibrillation prior to the procedure, all of whom underwent a concomitant ablation procedure. The first group of 78 concomitant ablation patients underwent a left-sided endocardial ablation procedure using a Cryoablation device. The second group of 34 ablation patients underwent a left-sided epicardial ablation procedure using an internally cooled monopolar RF device. No significant differences existed between groups in the preoperative data. All ablated patients were treated by the same Amiodarone protocol. Patients were followed for a minimum of 6 months for determining each ablated patient's rhythm, medication use, and overall health status.

Results: The AF-free rates of group I and group II patients were statistically equivalent for both ablation groups at all evaluation time points. None of the 112 patients treated with endoscopic mitral valve repair and ablative therapy experienced a specific patient injury attributable to ablation; no ablated patients died in hospital following the procedure; there were no esophageal perforations and no coronary artery stenosis due to the ablations in either ablation group. The rate of patients without AF was 74% in group I and 82% in group II in the 6-month follow-up. The group I pacemaker implantation rate of 14% was significantly higher than non-ablated group (4.7%), but the group II rate of 5.9% observed did not differ significantly from the non-ablated group.

Conclusions: It was shown with our results that one succeeds with the en bloc-ablation in treating patients with different kinds of atrial fibrillation with concurrent intervention in the mitral valve reliably and with a high rate. The combination of this procedure with endocardial interventional ablation technologies can possibly develop to a promising strategy in the hybrid therapy of the isolated chronic atrial fibrillation as a standalone procedure.