Background: Patients with a history of mitral valve (MV) surgery can
present with unique challenges during left atrial (LA) ablation due to
abnormal atrial substrate and descriptions of ablation in this cohort is
limited. We aim to evaluate LA ablation characteristics and outcomes in
patients with a history of mitral valve surgery. Objective: We
hypothesize that the success rate for ablations of LA arrhythmias in
patients with prior MV surgery will be inferior to patients without
prior MV surgery due to left atriopathy, presence of a MV prosthesis,
and a higher burden of pre-ablation LA scar. Methods: In this single
center, retrospective study, we evaluated patients who had a history of
MV surgery and underwent LA ablation between January 2013 and May 2019.
We analyzed baseline patient characteristics, type of MV disease and
surgery, available pre-ablation voltage maps, and ablation outcomes.
Results: We present a series of 20 patients who underwent a total of 30
LA ablation procedures. All 20 patients underwent pulmonary vein
isolation and 11 patients also underwent ablation for LA macro-reentrant
flutters. The majority of the patients (55%) were without recurrent
documented arrhythmias at a mean follow-up of 22 months post-ablation.
Two patients had acutely unsuccessful ablation. Conclusions: Although LA
ablation in patients with previous MV surgery can be challenging due to
abnormal atrial substrate and the presence of the valve prosthesis, the
majority of patients in our cohort experienced atrial arrhythmia free
survival at a mean follow-up of 22 months.