Catheter ablation versus surgical ablation combined with mitral valve surgery for nonparoxysmal atrial fibrillation in patients with moderate mitral regurgitation

Objective There are scarce comparative data on efficacy and procedural safety between radiofrequency catheter ablation (RFCA) and surgical ablation (SA) combined with mitral valve (MV) surgery for patients with nonparoxysmal atrial fibrillation (AF) and moderate mitral regurgitation (MR). Methods and Results This single-center, retrospective, and observational study enrolled 155 consecutive patients with nonparoxysmal AF and moderate MR, of which 98 underwent RFCA and 57 underwent SA combined with MV surgery. Circumferential pulmonary vein ablation, bidirectional block of lines, and disappearance of complex fractionated atrial electrograms were the endpoints of RFCA, while pulmonary vein isolation and left and right atrial incisions were performed in SA. At median 24-month follow-up, the primary outcome of atrial tachyarrhythmia (ATa) recurrence-free rate estimated by Kaplan-Meier analysis was higher in SA + MV surgery vs RFCA groups (64.2% vs 38.3%; P = 0.002), and comparable between patients with and without MV prolapse in SA + MV surgery group (64.7% vs 63.1%; P = 0.972). In adjusted Cox model, RFCA was associated with a hazard ratio for ATa recurrence of 2.27 (95% confidence interval, 1.02-5.05; P = 0.045). Patients with higher MR jet/LA (left atrial) area ratio had a higher risk of ATa recurrence in RFCA (P = 0.037) but not SA + MV (P = 0.529) groups. Conclusion SA + MV surgery yielded more favorable outcomes than RFCA for treating nonparoxysmal AF in patients with moderate MR. The MR jet/LA area ratio was positively associated with ATa recurrence rate in patients undergoing RFCA. MV prolapse did not affect prognosis in patients undergoing SA + MV surgery.