{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T23:52:26Z","timestamp":1769125946376,"version":"3.49.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Atrial fibrillation (AF) frequently accompanies rheumatic mitral valve disease (MVD) and adversely affects postoperative outcomes. Radiofrequency ablation (RFA) and cryoablation are commonly used during mitral valve surgery, but their comparative impact on atrial remodeling in this population remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort included 100 patients with rheumatic MVD and persistent AF who underwent mitral valve surgery with concomitant cryoablation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950) or RFA (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950) between June 2020 and June 2024 at centers in the Almaty region, Kazakhstan. Clinical and echocardiographic parameters were assessed preoperatively, within 48\u2005h postoperatively, and at 6\u2009\u00b1\u20092 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Cryoablation was associated with greater left atrial (LA) volume reduction immediately and at follow-up (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Multiple linear regression identified ablation modality as the only independent predictor of LA volume reduction (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u200927.9\u2005mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001), whereas duration of rheumatic disease, BMI, EuroSCORE II, and AF recurrence were not significant. At follow-up, the reduction in right atrial short-axis diameter was smaller after cryoablation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049), and stroke volume declined less compared with RFA (\u20131.2\u2009\u00b1\u200917.3\u2005mL vs. \u22127.3\u2009\u00b1\u200915.8\u2005mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006). Cardiopulmonary bypass time, aortic cross-clamp time, and postoperative symptom improvement were comparable between groups. Freedom from AF during follow-up was also similar (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.52).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with persistent AF and rheumatic MVD undergoing mitral valve surgery, cryoablation was associated with more pronounced early atrial reverse remodeling and better preservation of stroke volume compared with RFA, without differences in operative efficiency or short-term safety. These findings should be considered hypothesis-generating, and prospective randomized studies with standardized lesion sets are required to confirm modality-specific effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2025.1659310","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:53:32Z","timestamp":1769064812000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cryoablation and radiofrequency ablation during mitral valve surgery for rheumatic mitral valve disease: a retrospective cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Zhanar","family":"Nurbay","sequence":"first","affiliation":[{"name":"SCE City Cardiology Center","place":["Almaty, Kazakhstan"]},{"name":"Kazakhstan Medical University KSPH","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Auyeskhan","family":"Dzhumabekov","sequence":"additional","affiliation":[{"name":"Kazakhstan Medical University KSPH","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roza","family":"Kuanishbekova","sequence":"additional","affiliation":[{"name":"Kazakhstan Medical University KSPH","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rustem","family":"Tuleutayev","sequence":"additional","affiliation":[{"name":"JSC Research Institute of Cardiology and Internal Diseases","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nurzhan","family":"Musrepov","sequence":"additional","affiliation":[{"name":"Kazakhstan Medical University KSPH","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"zwaf138","DOI":"10.1093\/eurjpc\/zwaf138","article-title":"Prevalence of asymptomatic atrial fibrillation and risk factors associated with asymptomatic status: a systematic review and meta-analysis","volume":"32","author":"Pamporis","year":"2025","journal-title":"Eur J Prev Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"100786","DOI":"10.1016\/j.lanepe.2023.100786","article-title":"Atrial fibrillation: epidemiology, screening and digital health","volume":"37","author":"Linz","year":"2024","journal-title":"Lancet Reg Health Eur"},{"key":"B3","doi-asserted-by":"publisher","first-page":"20264","DOI":"10.1038\/s41598-024-71296-4","article-title":"Estimating the burden of atrial fibrillation and atrial flutter with projection to 2050 in Iran","volume":"14","author":"Soleimani","year":"2024","journal-title":"Sci Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2355","DOI":"10.3390\/diagnostics14212355","article-title":"Improvements in cardiopulmonary exercise test results in atrial fibrillation patients after radiofrequency ablation in Kazakhstan","volume":"14","author":"Beisenbayeva","year":"2024","journal-title":"Diagnostics"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ccep.2020.10.010","article-title":"Epidemiology of atrial fibrillation","volume":"13","author":"Zhang","year":"2021","journal-title":"Card Electrophysiol Clin"},{"key":"B6","doi-asserted-by":"publisher","first-page":"4230","DOI":"10.1002\/ehf2.14124","article-title":"Incidence and impact of atrial fibrillation in heart failure patients: real-world data in a large community","volume":"9","author":"Diaz","year":"2022","journal-title":"ESC Heart Fail"},{"key":"B7","doi-asserted-by":"publisher","first-page":"3093","DOI":"10.3390\/ijerph17093093","article-title":"A review of atrial fibrillation detection methods as a service","volume":"17","author":"Faust","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2361","DOI":"10.3889\/oamjms.2022.10775","article-title":"Risk factors for the development of atrial fibrillation in the Kazakh patients","volume":"10","author":"Taizhanova","year":"2022","journal-title":"Open Access Maced J Med Sci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS)","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e2242964","DOI":"10.1001\/jamanetworkopen.2022.42964","article-title":"Trends in use of oral anticoagulants in older adults with newly diagnosed atrial fibrillation, 2010\u20132020","volume":"5","author":"Ko","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.21037\/acs-2023-afm-0131","article-title":"Surgical ablation of atrial fibrillation during mitral valve surgery: a systematic review and meta-analysis","volume":"13","author":"Eranki","year":"2024","journal-title":"Ann Cardiothorac Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1519","DOI":"10.1016\/j.jtcvs.2018.09.023","article-title":"Concomitant ablation of atrial fibrillation in rheumatic mitral valve surgery","volume":"157","author":"Kim","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1330","DOI":"10.1016\/j.jtcvs.2017.02.027","article-title":"Expert consensus guidelines: examining surgical ablation for atrial fibrillation","volume":"153","author":"Ad","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.athoracsur.2022.09.036","article-title":"Long-term outcomes of concomitant surgical ablation for atrial fibrillation","volume":"116","author":"Cheng","year":"2023","journal-title":"Ann Thorac Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.amjcard.2023.09.088","article-title":"Surgical ablation for atrial fibrillation during mitral valve surgery: a systematic review and meta-analysis of randomized controlled trials","volume":"209","author":"Gemelli","year":"2023","journal-title":"Am J Cardiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1186\/s13019-024-02889-3","article-title":"Lesion durability found during mandated percutaneous catheter ablation after surgical cryo-ablation for treatment of non-paroxysmal atrial fibrillation","volume":"19","author":"Bulava","year":"2024","journal-title":"J Cardiothorac Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"289","DOI":"10.3390\/jcdd12080289","article-title":"Minimally invasive surgical strategies for the treatment of atrial fibrillation: an evolving role in contemporary cardiac surgery","volume":"12","author":"Benvegn\u00f9","year":"2025","journal-title":"J Cardiovasc Dev Dis"},{"key":"B18","doi-asserted-by":"publisher","first-page":"542","DOI":"10.21470\/1678-9741-2018-0130","article-title":"Which method to use for surgical ablation of atrial fibrillation performed concomitantly with mitral valve surgery: radiofrequency ablation versus cryoablation","volume":"33","author":"Vural","year":"2018","journal-title":"Braz J Cardiovasc Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1093\/icvts\/ivab322","article-title":"Results of concomitant cryoablation for atrial fibrillation during mitral valve surgery","volume":"34","author":"Bogachev-Prokophiev","year":"2022","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"ivaf217","DOI":"10.1093\/icvts\/ivaf217","article-title":"Long-term outcomes of concomitant left-sided cryoablation during totally endoscopic mitral valve surgery","volume":"40","author":"Bazhanov","year":"2025","journal-title":"Interdiscip Cardiovasc Thorac Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"245","DOI":"10.5606\/tgkdc.dergisi.2024.86520","article-title":"Surgical ablation of atrial fibrillation: rationale and technique","volume":"32","author":"Waterford","year":"2024","journal-title":"Turk Gogus Kalp Damar Cerrahisi Derg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"770221","DOI":"10.3389\/fcvm.2021.770221","article-title":"Preliminary results of cryoablation for surgical treatment of arrhythmias in adults with congenital heart disease","volume":"8","author":"Poretti","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1016\/j.jtcvs.2017.03.152","article-title":"The Cox-Maze IV procedure for atrial fibrillation is equally efficacious in patients with rheumatic and degenerative mitral valve disease","volume":"154","author":"Labin","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"135","DOI":"10.21037\/acs-2023-afm-0208","article-title":"Surgical options for atrial fibrillation treatment during concomitant cardiac procedures","volume":"13","author":"Baudo","year":"2024","journal-title":"Ann Cardiothorac Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2665","DOI":"10.1016\/j.jacep.2023.08.013","article-title":"Atrial ablation lesion evaluation by cardiac magnetic resonance","volume":"9","author":"Hopman","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"3461","DOI":"10.21037\/jtd-23-1984","article-title":"Surgical treatment of atrial fibrillation in mitral valve surgery: a narrative review","volume":"16","author":"Zou","year":"2024","journal-title":"J Thorac Dis"},{"key":"B27","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.hlc.2024.10.014","article-title":"Radiofrequency and cryoablation as energy sources in the cox-maze procedure: a meta-analysis of rhythm outcomes","volume":"34","author":"Baudo","year":"2025","journal-title":"Heart Lung Circ"},{"key":"B28","doi-asserted-by":"publisher","first-page":"117","DOI":"10.21037\/acs-2023-afm-20","article-title":"Atrial fibrillation ablation during robotic mitral valve surgery: a systematic review and meta-analysis","volume":"13","author":"Eranki","year":"2024","journal-title":"Ann Cardiothorac Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.xjtc.2024.05.007","article-title":"Efficacy of four different left atrial appendage closure techniques during cardiac surgery\u2014a transesophageal echocardiography follow-up study","volume":"26","author":"Petersen","year":"2024","journal-title":"JTCVS Tech"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e02","DOI":"10.15420\/aer.2021.63","article-title":"Ablation lesion assessment with MRI","volume":"11","author":"Mont","year":"2022","journal-title":"Arrhythm Electrophysiol Rev"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1659310\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:53:50Z","timestamp":1769064830000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1659310\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,22]]},"references-count":30,"alternative-id":["10.3389\/fcvm.2025.1659310"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1659310","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,22]]},"article-number":"1659310"}}