Lucia D’ Angelo

BackgroundFor patients with rheumatic mitral stenosis (MS) undergoing percutaneous balloon mitral commissurotomy (PBMC) complicated with atrial fibrillation (AF), the clinical outcomes of radiofrequency catheter ablation (RFCA) remain unclear. This study aimed to investigate RFCA for AF in MS patients undergoing PBMC.MethodsWe retrospectively identified 3,895 patients who underwent AF ablation, including 50 MS patients who received PBMC simultaneously (combined group) and 3,845 general AF patients (control group). Propensity score matching was performed to balance baseline characteristics.ResultsAfter matching covariates, 43 well-balanced patient pairs were included. At 1 year, the rate of freedom from AF/AT was significantly higher in the combined group (79.1% vs. 51.2%; P = 0.0076). There were no significant differences in the incidence of major adverse cardiovascular and cerebrovascular events within 1 year (7.0% vs. 4.7%; P = 1.000) and the severity of mitral regurgitation. Both groups of patients free from AF/AT had significant postoperative reductions in left atrial size, with a more pronounced reduction observed in the control group. A subgroup analysis of 16 pairs of patients undergoing intraoperative left atrial voltage mapping revealed that with comparable left atrial volume index, the low-voltage area burden was significantly lower in the combined group.Conclusion sOur study, featuring the largest sample size of patients with MS undergoing PBMC combined with RFCA, is the first to reveal that RFCA for AF in this specific patient group demonstrates superior efficacy compared with general patients.