AF Ablation Challenges in Mitral Valve Surgery


Atrial fibrillation (AF) is a common cardiac condition that often coexists with mitral valve disease. It is recommended that patients scheduled for mitral valve surgery also undergo concomitant AF ablation. However, a significant proportion of these patients do not welcome this conjunctive treatment. This article summarizes a study conducted by Mehaffey et al., titled “Barriers to atrial fibrillation excision during mitral valve surgery,” which explores the challenges faced in adopting this best practice.

Surveying Cardiac Surgeons

A survey of cardiac surgeons reveals barriers to AF ablation adoption in mitral valve surgery, assessing experience, education, knowledge, and perspectives.

Survey Findings

Out of the 135 cardiac surgeons approached 66 of them responded to the survey, representing a response rate of 48.9%. The majority of the respondents (80.3%) reported being “very comfortable with” or “frequently using” cryoablation, while 83.1% reported the same for radiofrequency ablation. Only a small proportion (12.1%) expressed a requirement for further noesis on the subject

Around 50% of cardiac surgeons (47.0%) learned about AF ablation during fellowships or specific courses, indicating diverse practice patterns.

Identifying Challenges

While some surgeons reported encountering no difficulties in performing AF ablation during mitral valve surgery, others identified specific challenges. Factors such as longer cross-clamp times increased patient risks, and more frequent arrhythmias were cited as hurdles to performing concurrent AF ablation.

Potential Interventions

To overcome the challenges associated with AF ablation during mitral valve surgery, respondents suggested several interventions. Improved support, protocols, data usage, and educational initiatives improved cardiology and electrophysiology.

Variability in Practice Patterns

The survey findings highlighted a significant variation in the awareness and adherence to evidence-based recommendations and practice patterns related to concurrent AF ablation. This indicates a need for standardized approaches and better dissemination of knowledge in this field.


The adoption of atrial fibrillation ablation during mitral valve surgery faces various challenges. The study conducted by Mehaffey et al. shed light on the barriers identified by cardiac surgeons, such as longer cross-clamp times and increased patient risks. By addressing these challenges through improved support, protocols, and education, the implementation of concurrent AF ablation can be enhanced. Standardizing practices and promoting evidence-based recommendations will contribute to improved patient outcomes in this context.

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