Radiofrequency catheter ablation of newly diagnosed paroxysmal atrial fibrillation in a patient with mitral and aortic mechanical valves: A case study

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Background: Radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) in patients with prosthetic valve is still a challenge because of the higher recurrence rate and difficult manipulation of catheters in the left atrium which may lead to higher risk of complications. We presented the first AF ablation in Vietnam of a patient who had mitral and aortic mechanical valves. Case summary: A 54-year-old man who had two mechanical heart valves (mitral and aortic) implanted 16 years ago was newly diagnosed with symptomatic paroxysmal AF for the past 4 months at a province general hospital. The patient was treated with amiodarone but still symptomatic and could not tolerate the medication. A referral to our centre was made for consideration of radiofrequency catheter ablation. Sinus rhythm was successfully restored after pulmonary vein isolation, cavo-tricuspid isthmus ablation, and tailor-ablation. At the last follow-up at 9-months post-ablation, the patient was still in sinus rhythm and asymptomatic. Discussion: Catheter ablation of AF in patients with mechanical heart valve(s) is challenging due to increased difficulty in accessing the left atrium as well as catheter manipulation and ablation inside the atrium. Nevertheless, this procedure could be safely performed in high experience centres.

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