Objective: The purpose of this study is to investigate the mechanism and the effectiveness of ablation of atrial tachycardia (AT) recurring after atrial fibrillation (AF) ablation in patients with rheumatic valvular disease (RVD) and mitral valve prosthesis.
Methods: Twenty-eight consecutive patients with RVD and mitral valve prosthesis and a 1:2 matched control group (n = 56) without RVD underwent reablation for recurrent AT after catheter ablation of long-standing persistent AF.
Results: Macro- or localized reentrant ATs were identified in 47 (87 %) of 54 ATs from RVD group and in 65 (78.3 %) of 83 ATs from control. There were more average ATs per patient in the RVD group than in the control (1.9 ± 0.6 vs.1.5 ± 0.6, P = 0.002). The proportion of patients having ≥2 ATs was significantly higher in the RVD group than in the control (78.6 vs.41.1 %, P = 0.001). In the RVD group, ATs were successfully ablated in 44 (81.5 %) of 54 ATs and terminated in 18 (64.3 %) of 28 patients. In the control, ATs were successfully ablated in 72 (86.7 %) of 83 ATs and terminated in 45 (80.4 %) of 56 patients, P = 0.54 and 0.10, respectively. After a mean follow-up of 13 months, 16 patients (57.1 %) from the RVD group and 45 patients (80.4 %) from the control were free of further recurrence, P = 0.02.
Conclusions: Macro- or localized reentries were the predominant type of recurrent AT after long-standing persistent AF ablation in both the RVD and the control groups. Compared with patients without RVD, patients with RVD had more average number of ATs and had higher probability of further recurrence despite the similar acute effectiveness of reablation.