Clinical Efficacy of Bipolar Radiofrequency Ablation Procedure Combined with One-stage Operation of Open-heart Surgery for 137 Patients with Atrial Fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 WUQi-cai , LIUJi-chun , YUBen-tong , WANLi , TANGJian , GULiang , WANGQun , XUQi-rong

Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, P. R. China;

Corresponding?author：

WUQi-cai, Email: wuqicai13970012836@163.com

Keywords：

Atrial fibrillation; Bipolar radiofrequency ablation procedure; Cardiac operation

DOI：

10.7507/1007-4848.20150203

Video：

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Objective To evaluate the efficacy of bipolar radiofrequency ablation procedure for atrial fibrillation (AF) during the open-heart surgery. Methods We retrospectively analyzed the clinical data of 137 heart disease patients combined with AF (21 patients combined with left atrial thrombus) who underwent one-stage operation of open-heart surgery and bipolar radiofrequency ablation from May 2009 to June 2014. There were 61 males and 76 females at age of 35-73(48.3±11.6)years. The patients received amiodarone treatment for 6 months after surgery and regular follow-up. The sinus rhythm conversion rate, cardiac function before and after operation, survival rate after operation, the incidence of thromboembolism and other complications were recorded. Results The average cardiopulmonary bypass time during operation was 122±38 min, the average aortic crossclamp time was 78±22 min, and the average radiofrequency ablation time was 20±4 min. The atrial fibrillation was successfully ablated in 130 patients on the same day of surgery with conversion rate of 94.9%. The atrial fibrillation was converted to sinus rhythm in 114 patients, and converted to junctional cardiac arrhythmia in 16 patients. Two patients died during the perioperative period with death rate of 1.5% in hospital. The conversion rate was 81.5% (110/135), 88.1% (111/126), 83.1% (74/89), and 83.0% (39/47) respectively at one month, six months, one year, and two years after surgery, respectively. The survival rate was 96.6% (86/89) and 93.6% (44/47) at one year and two years after surgery. No thromboembolism occurred during the long-term follow-up period. Conclusion Bipolar radiofrequency ablation procedure selectively performed during open-heart surgery can cure atrial fibrillation, only increases cardiopulmonary bypass and aortic crossclamp time slightly. The short- and mid-term efficacy is satisfactory with high conversion rate of sinus rhythm. The long-term effect still needs further observation.

Citation： WUQi-cai, LIUJi-chun, YUBen-tong, WANLi, TANGJian, GULiang, WANGQun, XUQi-rong. Clinical Efficacy of Bipolar Radiofrequency Ablation Procedure Combined with One-stage Operation of Open-heart Surgery for 137 Patients with Atrial Fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(9): 807-811. doi: 10.7507/1007-4848.20150203 Copy

1.	Marchilnski FE, Callans D, Dixit S, et al. Efficacy and safety of targeted focal ablation versus PV isolation assisted by magnetic electroanatomic mapping. J Cardiovase Elctrophysiol, 2003, 14(4):358-365.
2.	王堅剛, 孟旭, 李暉, 等. 心內膜合并心外膜改良迷宮射頻消融治療心房纖顫. 中華外科雜志, 2007, 45(6):415-418.
3.	Marui A, Saji Y, Nishina T, et al. Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function. J Thorac Cardiovasc Surg, 2008, 135(6):1297-1305.
4.	Deneke T, Khargi K, Lemke B, et al. Intra-operative cooled-tip radiofrequency linear atrial ablation to treat permanent atrial fibrillation. Eur Heart J, 2007, 28(23):2909-2914.
5.	Fuster V, Ryden LE, Asinger RW, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation:Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences(Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation) Developed in Collaboration with the North American Society of Pacing and Electrophysiology. Circulation, 2001, 104(17):2118-2150.
6.	Kamohara K, Fukamachi K, Ootaki Y, et al. A novel device for left atrial appendage exclusion. J Thorac Cardiovasc Surg, 2005, 130(6):1639-1644.
7.	Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure:assessment by transesophageal echocardiography. J Am Coll Cardiol, 2008, 52(11):924-929.
8.	Badhwar V, Rovin JD, Davenport G, et al. Left atrial reduction enhances outcomes of modified maze procedure for permanent atrial fibrillation during concomitant mitral surgery. Ann Th orac Surg, 2006, 82(5):1758-1764.
9.	肖錫俊, 朱喜亮, 唐紅, 等. 二尖瓣置換術后患者遠期超聲心動圖特征及其臨床意義. 中國胸心血管外科臨床雜志, 2013, 20(2):148-151.
10.	符竣, 王波, 陶涼, 等. 兩種不同射頻消融方式治療風濕性心瓣膜病合并永久性心房顫動的療效比較. 中國胸心血管外科臨床雜志, 2013, 20(3):304-307.
11.	Ishii Y, Nitta T, Fujii M, et al. Serial change in the atrial transport function after the radial incision approach. Ann Thorac Surg, 2001, 71(2):572-576.
12.	Knaut M, Tugtckin SM, Spitzer S, et al. Combined atrial fibrillation and mitral valve surgery using microwave surgery. Semin Thorac Cardiovasc Surg, 2002, 14(3):226-231.
13.	Sestito A, Molina E. Atrial fibrillation and the pharmacological treatment:the role of propafenone. Eur Rev Med Pharmacol Sci, 2012, 16(2):242-253.
14.	楊嵩, 張希, 唐白云, 等. 永久性心房顫動外科雙極射頻消融術的效果. 中國胸心血管外科臨床雜志, 2012, 19(3):254-257.
15.	Beyer E, Lee R, Lam BK. Point:minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation:early multicenter results. J Thorac Cardiovasc Surg, 2009, 137(3):521-526.
16.	Albrecht A, Kalil RA, Schuch L, et al. Randomized study of surgical isolation of the pulmonary veins for correction of permanent atrialfi brillation associated with mitral valve disease. J Thorac Cardiovasc Surg, 2009, 138(2):454-459.
17.	Cheng DC, Ad N, Martin J, et al. Surgical ablation for atrial fibrillation in cardiac surgery:a meta-analysis and systematic review. Innovations(Phila), 2010, 5(2):84-96.
18.	Ad N, Cheng DC, Martin J, et al. Surgical Ablation for Atrial Fibrillation in Cardiac Surgery:A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery(ISMICS) 2009. Innovations(Phila), 2010, 5(2):74-83.
19.	Ouyang F, Bansch D, Ernst S, et al. Complete isolation of left atrium surrounding the pulmonary veins:New insights from the doublet lasso technique in paroxysmal atrial fibrillation. Circulation, 2004, 110(15):2090-2096.
20.	Delise P, Bonso A, Coro L, et al. Pacemapping of the triangle of Koch:a simple method to reduce the risk of atrioventricular block during radiofrequency ablation of atrioventricular node reentrant tachycardia. Pacing Clin Electrophysiol, 2001, 24(12):1725-1731.
21.	Gillinov AM, Pettersson G, Rice TW. Esophageal injury during radiofrequency ablation for atrial fibrillation. J Thorac Cardiovasc Surg, 2001, 122(6):1239-1240.
22.	楊寶峰, 主編. 藥理學. 第6版. 北京:人民衛生出版社, 2005. 217-218.
23.	Nitta T. Surgery for atrial fibrillation:a worldwide review. Semin Thorac Cardiovasc Surg, 2007, 19(1):3-8.
24.	崔永強, 孟旭, 李暉, 等. 心臟外科手術治療心房顫動各種消融能源的應用進展. 中國循環雜志, 2007, 22(2):164-166.
25.	Shen J, Bailey MS, Damiano RJ Jr. The surgical treatment of atrial fibrillation. Heart Rhythm, 2009, 6(8 Suppl):S45-S50.
26.	Khargi K, Keyhan-Falsafi A, Hutten BA, et al. Surgical treatment of atrial fibrillation:a systematic review. Herzschrittmacherther Elektrophysiol, 2007, 18(2):68-76.

1. Marchilnski FE, Callans D, Dixit S, et al. Efficacy and safety of targeted focal ablation versus PV isolation assisted by magnetic electroanatomic mapping. J Cardiovase Elctrophysiol, 2003, 14(4):358-365.
2. 王堅剛, 孟旭, 李暉, 等. 心內膜合并心外膜改良迷宮射頻消融治療心房纖顫. 中華外科雜志, 2007, 45(6):415-418.
3. Marui A, Saji Y, Nishina T, et al. Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function. J Thorac Cardiovasc Surg, 2008, 135(6):1297-1305.
4. Deneke T, Khargi K, Lemke B, et al. Intra-operative cooled-tip radiofrequency linear atrial ablation to treat permanent atrial fibrillation. Eur Heart J, 2007, 28(23):2909-2914.
5. Fuster V, Ryden LE, Asinger RW, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation:Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences(Committee to Develop Guidelines for the Management of Patients with Atrial Fibrillation) Developed in Collaboration with the North American Society of Pacing and Electrophysiology. Circulation, 2001, 104(17):2118-2150.
6. Kamohara K, Fukamachi K, Ootaki Y, et al. A novel device for left atrial appendage exclusion. J Thorac Cardiovasc Surg, 2005, 130(6):1639-1644.
7. Kanderian AS, Gillinov AM, Pettersson GB, et al. Success of surgical left atrial appendage closure:assessment by transesophageal echocardiography. J Am Coll Cardiol, 2008, 52(11):924-929.
8. Badhwar V, Rovin JD, Davenport G, et al. Left atrial reduction enhances outcomes of modified maze procedure for permanent atrial fibrillation during concomitant mitral surgery. Ann Th orac Surg, 2006, 82(5):1758-1764.
9. 肖錫俊, 朱喜亮, 唐紅, 等. 二尖瓣置換術后患者遠期超聲心動圖特征及其臨床意義. 中國胸心血管外科臨床雜志, 2013, 20(2):148-151.
10. 符竣, 王波, 陶涼, 等. 兩種不同射頻消融方式治療風濕性心瓣膜病合并永久性心房顫動的療效比較. 中國胸心血管外科臨床雜志, 2013, 20(3):304-307.
11. Ishii Y, Nitta T, Fujii M, et al. Serial change in the atrial transport function after the radial incision approach. Ann Thorac Surg, 2001, 71(2):572-576.
12. Knaut M, Tugtckin SM, Spitzer S, et al. Combined atrial fibrillation and mitral valve surgery using microwave surgery. Semin Thorac Cardiovasc Surg, 2002, 14(3):226-231.
13. Sestito A, Molina E. Atrial fibrillation and the pharmacological treatment:the role of propafenone. Eur Rev Med Pharmacol Sci, 2012, 16(2):242-253.
14. 楊嵩, 張希, 唐白云, 等. 永久性心房顫動外科雙極射頻消融術的效果. 中國胸心血管外科臨床雜志, 2012, 19(3):254-257.
15. Beyer E, Lee R, Lam BK. Point:minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation:early multicenter results. J Thorac Cardiovasc Surg, 2009, 137(3):521-526.
16. Albrecht A, Kalil RA, Schuch L, et al. Randomized study of surgical isolation of the pulmonary veins for correction of permanent atrialfi brillation associated with mitral valve disease. J Thorac Cardiovasc Surg, 2009, 138(2):454-459.
17. Cheng DC, Ad N, Martin J, et al. Surgical ablation for atrial fibrillation in cardiac surgery:a meta-analysis and systematic review. Innovations(Phila), 2010, 5(2):84-96.
18. Ad N, Cheng DC, Martin J, et al. Surgical Ablation for Atrial Fibrillation in Cardiac Surgery:A Consensus Statement of the International Society of Minimally Invasive Cardiothoracic Surgery(ISMICS) 2009. Innovations(Phila), 2010, 5(2):74-83.
19. Ouyang F, Bansch D, Ernst S, et al. Complete isolation of left atrium surrounding the pulmonary veins:New insights from the doublet lasso technique in paroxysmal atrial fibrillation. Circulation, 2004, 110(15):2090-2096.
20. Delise P, Bonso A, Coro L, et al. Pacemapping of the triangle of Koch:a simple method to reduce the risk of atrioventricular block during radiofrequency ablation of atrioventricular node reentrant tachycardia. Pacing Clin Electrophysiol, 2001, 24(12):1725-1731.
21. Gillinov AM, Pettersson G, Rice TW. Esophageal injury during radiofrequency ablation for atrial fibrillation. J Thorac Cardiovasc Surg, 2001, 122(6):1239-1240.
22. 楊寶峰, 主編. 藥理學. 第6版. 北京:人民衛生出版社, 2005. 217-218.
23. Nitta T. Surgery for atrial fibrillation:a worldwide review. Semin Thorac Cardiovasc Surg, 2007, 19(1):3-8.
24. 崔永強, 孟旭, 李暉, 等. 心臟外科手術治療心房顫動各種消融能源的應用進展. 中國循環雜志, 2007, 22(2):164-166.
25. Shen J, Bailey MS, Damiano RJ Jr. The surgical treatment of atrial fibrillation. Heart Rhythm, 2009, 6(8 Suppl):S45-S50.
26. Khargi K, Keyhan-Falsafi A, Hutten BA, et al. Surgical treatment of atrial fibrillation:a systematic review. Herzschrittmacherther Elektrophysiol, 2007, 18(2):68-76.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Efficacy of Bipolar Radiofrequency Ablation Procedure Combined with One-stage Operation of Open-heart Surgery for 137 Patients with Atrial Fibrillation

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