Valvular versus non valvular AFIB differential diagnosis

It seems obvious that valvular AFIB, would likely not be successfully treated with ablation of the pulmonary veins. So the diagnosis of valvular AFIB Ihas particular significance.
How is valve derived AFIB diagnosed to differentiate between non-valve?

How to define valvular afib seems to have been a debatable question for a number of years now, but the only real debate seems to be which anticoagulation therapy to use, not whether ablation is appropriate or not.

The most common definition of valvular afib I can find is:

https://www.jacc.org/doi/10.1016/j.jcin.2020.05.049

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valvular AF was defined as AF in the setting of concomitant mitral stenosis or the presence of a mitral valve prosthesis.

My choice of papers to quote is somewhat arbitrary because every study I found uses the same definition.

It was surprisingly hard to find studies looking at ablation for valvular afib, but this one seems to sum it up:

https://pubmed.ncbi.nlm.nih.gov/20550616/

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The patients with VHD undergoing AF ablation are less likely to remain in sinus rhythm at long term without AADs than those without VHD.

So, the short answer seems to be that ablation just isn't effective with valvular afib, but just because you have valve issues doesn't mean you have valvular afib. To be diagnosed with valvular afib, you have to have mitral stenosis or a mitral valve prosthesis. So unless you have that diagnosis and afib, you don't have valvular afib.

Thanks Cary
Is it your sense that the valve in question is the mitral, as opposed to the any of the other 3 valves?

If a diagnosis were clearly valvular AFIB, then the correction of the valve is priority. (Of course this is just my non-expert opinion!)

Yes, the mitral valve seems to be the focus, not the other valves. Correcting it would be the priority, but since correcting it might mean valve replacement, that would still leave you with valvular afib by the definition they use.

Thanks Cary

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valvular AF was defined as AF in the setting of concomitant mitral stenosis or the presence of a mitral valve prosthesis

I don't have either of these things and was diagnosed with valvular afib at Cedars-Sinai over a year ago. From what I was told, I had mitral valve prolapse with severe regurgitation where about 50% of blood was flowing back into the left atria. Based on all the other tests they conducted, it was deemed my afib was a direct result of my left atria becoming severely enlarged due to the severe regurgitation.

Before searching extensively and finding Cedars, a local hospital I was admitted too had multiple cardiologists and even EPs tell me I just needed an ablation and not to worry about my mitral valve. Fortunately I didn't move forward with an ablation at that time as it would of done nothing and my mitral valve would still need repair anyway afterwards.

I was then told by that same hospital and one of the interventionalists there, that in my case I would never get back into sinus rhythm as my left atria was severely enlarged and it wouldn't reduce enough in size to maintain NSR. Well, since I had my valve repaired had a Maze procedure and a touch up ablation after for Flutter on the right side, my left Atria has nearly reduced to normal size and I have been in NSR 100% of the time since the blanking period with a resting heart rate around 65bpm.

Great result, cornerbax. I'm glad it worked so well for you.

Wow! Nice!