J Thorac Cardiovasc Surg. 2026 Jan 16:S0022-5223(26)00018-8. doi: 10.1016/j.jtcvs.2025.12.033. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate whether the impacts of AF ablation differs between rheumatic and degenerative MV surgeries, given concerns that atrial fibrosis in rheumatic disease may reduce ablation efficacy.
METHODS: Consecutive patients undergoing rheumatic or degenerative MV surgery between 2000 and 2022 were retrospectively examined. Primary endpoint was death, and secondary endpoint was composite of death, readmission due to heart failure and stroke. In patients with AF, outcomes between ablation and no-ablation groups were compared using inverse probability of treatment weighting (IPTW) to adjust for selection bias.
RESULTS: Among 4,232 subject patients (age, 56.3±12.7 yrs; 2,357 females), rheumatic and degenerative MV disease were present in 2,606 and 1,626 patients, respectively, with preoperative AF more frequent in rheumatic than degenerative disease (71.9% vs. 34.6%, P<0.001). Overall, rates of primary and secondary endpoints were highest in AF without ablation, followed by with ablation and those with sinus rhythm (P<0.001 for both). In patients with AF, concomitant ablation was associated with reduced adjusted risks of death (HR, 0.6, 95% CI, 0.49-0.75, P<0.001) and composite outcome (HR, 0.69, 95% CI, 0.57-0.83, P<0.001). In subgroup analyses, no significant interactions were found between valve pathology and ablation for death (P=0.35) and composite outcomes (P=0.87).
CONCLUSIONS: Combining AF ablation in rheumatic MV surgery was associated with significantly improved long-term clinical outcomes, comparable to those observed in degenerative MV disease.
PMID:41548839 | DOI:10.1016/j.jtcvs.2025.12.033