Background: Patients with a history of mitral valve (MV) surgery can present with unique challenges during left atrial (LA) ablation due to the abnormal atrial substrate and descriptions of ablation in this cohort is limited.
Objective: We aim to evaluate the outcomes of LA ablations for patients with a history of MV surgery.
Methods: Patients were included if they had a history of MV surgery and underwent LA ablation between June 2016 and May 2019.
Results: We present a series of 20 patients with a history of MV surgery who underwent a total of 30 LA ablation procedures from Jan 2013 to May 2019. Baseline demographics including type of arrhythmia and MV disease and surgery type were collected (Figure 1A). Up to 4 LA ablation procedures were performed per patient with 30% of the patients undergoing more than 1 ablation. All 20 patients underwent pulmonary vein isolation and 10 also had ablation for mitral annular flutter. 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 including one patient whose procedure was terminated due to compromise of their mechanical MV prosthesis.
Conclusion: Although left atrial ablation in patients with previous mitral valve surgery can be challenging due to abnormal atrial substrate and the valve prosthesis, the majority of patients in our cohort had a high rate of atrial arrhythmia free survival with a relatively low rate of complications.