Clinical Analysis of Cardiac Surgery Concomitant with Bipolar Radiofrequency Ablation for Atrial Fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LiuJian , LiuYong , HuangJi-xiu , LinXiao-bin , FuJian , TangXian-cheng , ZHangJing , PengXue-hua

Department of Cardiovascular surgery, People's Hospital of Jianyang City, Jianyang 641400 sichuan, P. R. China;

Corresponding?author：

Keywords：

Atrial fibrillation; Open-heart surgery; Radiofrequency ablation

DOI：

10.7507/1007-4848.20150282

Video：

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Objective To evaluate the efficacy and safety of cardiac surgery concomitant with bipolar radiofrequency ablation(BRFA) for the patients with heart disease and atrial fibrillation(AF). Methods From April 2008 to September 2014, clinical data of 167 patients(43 males, 124 females) of organic-heart-disease patients combined with atrial fibrillation were analyzed retrospectively in our hospital. Within 167 patients, 102 patients underwent bipolar radiofrequency ablation without aortic cross-clamping were as a trial group and the other 65 patients underwent cardiac surgery and bipolar radiofrequency ablation with aortic cross-clamping were as a control group. And there were no significant difference in the age and gender between the two groups. Results The time of radiofrequency ablation was 23.1±5.0 minutes in all the patients and there was no significant difference between the two groups(P=0.279). The extracorporeal circulation time was 156.6±56.4 minutes and the aortic cross-clamping time was 82.1±42.6 minutes. There was a significant difference between two groups in extracorporeal circulation time and aortic cross-clamping time. One patient underwent bipolar radiofrequency ablation with aortic cross-clamping died of severe pulmonary infection and multiple organ dysfunction syndrome(MODS) in one month after the surgery. The duration of follow-up was 1-77(35.3±3.5) months. The sinus rhyme conversion rate was estimated by electrocardiogram(ECG) in 1 month, 3 months, 6 months, 12 months, 36 months, 60 months after operation. The sinus rhyme conversion rates were 85.3%(133/156), 83.4%(126/151), 82.7%(115/139), 77.0%(94/122), 75.9%(41/54), and 72.0%(18/25). There was no significant difference during the follow-up in all of the sinus rhyme conversion rate. During the fellow-up, 2 patients died. One died after 1 month and another died after 6 months after their hospital-discharges. Conclusion The efficacy and safety of cardiac surgery concomitant with bipolar radiofrequency ablation is satisfied. It can reduce the time of myocardial ischemia in bipolar radiofrequency ablation without aortic cross-clamping. It is beneficial to critical patients.

Citation： LiuJian, LiuYong, HuangJi-xiu, LinXiao-bin, FuJian, TangXian-cheng, ZHangJing, PengXue-hua. Clinical Analysis of Cardiac Surgery Concomitant with Bipolar Radiofrequency Ablation for Atrial Fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(12): 1133-1137. doi: 10.7507/1007-4848.20150282 Copy

1.	Sims JB, Roberts WC. Comparison of findings in patients with versus without atrial fibrillation just before isolated mitral valve replacement for rheumatic mitral stenosis (with or without associated mitral regurgitation). Am J Cardiol, 2006, 97(9):1035-1038.
2.	Hussein AA, Wazni OM, Harb S, et al. Radiofrequency ablation of atrial fibrillation in patients with mechanical mitral valve prostheses. J Am Col Cardiol, 2011, 58(6):596-602.
3.	Sueda T, Nagata H, Orihashi K, et al. Efficacy of simple left atrial procedure for chronic atrial fibrillation in mitral valve operations. Ann Thorac Surg, 1997, 63(4):1070-1107.
4.	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.
5.	Caldwell JC, Mamas MA. Heart failure, diastolic dysfunction and atrial fibrillation; mechanistic insight of a complex inter-relationship. Heart Fail Rev, 2012, 17(1):27-33.
6.	劉泓, 肖穎彬, 陳林, 等. 瓣膜置換同期雙極射頻消融術對心功能恢復的影響. 中國胸心血管外科臨床雜志, 2015, 22(5):428-433.
7.	侯邁. 心房顫動的外科治療. 中國胸心血管外科臨床雜志, 2005, 12(5):346-349.
8.	卞曉明. 心房顫動的外科治療策略. 醫學與哲學, 2009, 30(4):16-19.
9.	武忠, 陳保俊, 曹彬, 等. 心內直視下射頻消融改良迷宮術治療心房顫動.中國胸心血管外科臨床雜志, 2007, 14(4):308-309.
10.	鄔曉臣, 張進寶, 歐陽輝, 等. 二尖瓣置換同期行雙極射頻消融術治療風濕性二尖瓣病變合并心房顫動的療效分析. 中國胸心血管外科臨床雜志, 2014, 21(6):827-829.
11.	Lall SC, Melby SJ, Voeller RK, et al. The effect of ablation technology on surgical outcomes after the Cox-maze procedure:a propensity analysis. J Thorac Cardiovasc Surg, 2007, 133(2):3893-3896.
12.	劉健, 黃擊修, 林小彬, 等. 不阻斷升主動脈下直視雙極射頻消融治療心房顫動. 中國胸心血管外科臨床雜志, 2010, 17(5):425-427.
13.	姜兆磊, 梅舉, 馬南, 等. 新型改良心外射頻消融術治療主動脈瓣病變合并心房顫動的療效分析. 中國胸心血管外科臨床雜志, 2015, 22(8):725-728.
14.	程偉, 肖穎彬, 陳林, 等. 胸骨下段切口心臟不停跳技術在二尖瓣置換術中的應用. 中國胸心血管外科臨床雜志, 2013, 20(1):33-37.
15.	Bonchek LI, Burlingme MW, Vazales BE, et al. Applicability of noncardioplegic coronary bypass to high-risk patients. Selection of patients, technique and clinical experience in 3000 patients. J Thorac Cardiovasc Surg, 1992, 103 (2):230-237.
16.	Grrola LR, Olivereira SA, Moreira LP, et al. Blood cardioplegia with warm reperfusion versus intermittent aortic cross clamping in myocardial revascularization:randomized controlled trial. J Thorac Cardiovasc Surg, 1993, 106(3):491-496.
17.	Louagie Y, Buche M, Eucher JC, et al. Improved patient survival withconcomitant cox maze Ⅲ procedure compared with heart surgery alone. Ann Thorac Surg, 2009, 87(2):440-446.
18.	王巍, 安君, 楊岷, 等. 二尖瓣置換術中射頻消融治療慢性心房顫動的療效分析. 中國胸心血管外科臨床雜志, 2013, 20(6):664-668.
19.	Gillinov AM. Advances in surgical treatment of atrial fibrillation. Stroke, 2007, 38(2 Suppl):618-623.
20.	Beukema WP, Sie HT, Misier AR, et al. Intermediate to long term results of radiofrequency modified maze procedure as an adjunct to open-heart surgery. Ann Thorac Surg, 2008, 86(5):1409-1414.
21.	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.
22.	張大國, 劉秀倫, 范壽年, 等. 換瓣術中單極和雙極射頻消融治療風濕性心臟病合并心房纖顫的臨床研究. 重慶醫學, 2012, 41(11):1115-1117.
23.	Oueida F, Elawady MA, Eskander K, et al. Radiofrequency ablation of atrial fibrillation during mitral valve surgery. Asian Cardiovasc Thorac Ann. 2014, 14(3):210-218.
24.	王輝山, 汪曾煒, 李新民, 等. 雙極射頻消融迷宮術后同步電復律治療心房顫動. 中國胸心血管外科臨床雜志, 2011, 18(4):359-361.
25.	Cox JL, Ad N, Palazzo T, et al. Current status of the Maze procedurefor the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg, 2000, 12(1):15-19.
26.	Gillinov AM, Wolf RK. Surgical ablation of atrial fibrillation. Prog Cardiovasc Dis, 2005, 48(3):169-177.
27.	Pasic M, Bergs P, Müller P, et al. Intraoperative radiofrequency maze ablation for atrial fibrillation:the Berlin modification. Ann Thorac Surg, 2001, 72(5): 1484-1490.
28.	Geidel S, Ostermeyer J, Lass M, et al. Three years experience with monopolar and bipolar radiofrequeney ablation surgery in patients with permanent atrial fibrillation. Eur J Cardiothorae Surg, 2005, 27(2):243-249.
29.	Dunninga J, Nagendranb M, Alfieric OR, et al. EACTS guideline for the surgical treatment of atrial fibrillation. Eur J Cardiothorac Surg, 2013, 44(5):777-791.

1. Sims JB, Roberts WC. Comparison of findings in patients with versus without atrial fibrillation just before isolated mitral valve replacement for rheumatic mitral stenosis (with or without associated mitral regurgitation). Am J Cardiol, 2006, 97(9):1035-1038.
2. Hussein AA, Wazni OM, Harb S, et al. Radiofrequency ablation of atrial fibrillation in patients with mechanical mitral valve prostheses. J Am Col Cardiol, 2011, 58(6):596-602.
3. Sueda T, Nagata H, Orihashi K, et al. Efficacy of simple left atrial procedure for chronic atrial fibrillation in mitral valve operations. Ann Thorac Surg, 1997, 63(4):1070-1107.
4. 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.
5. Caldwell JC, Mamas MA. Heart failure, diastolic dysfunction and atrial fibrillation; mechanistic insight of a complex inter-relationship. Heart Fail Rev, 2012, 17(1):27-33.
6. 劉泓, 肖穎彬, 陳林, 等. 瓣膜置換同期雙極射頻消融術對心功能恢復的影響. 中國胸心血管外科臨床雜志, 2015, 22(5):428-433.
7. 侯邁. 心房顫動的外科治療. 中國胸心血管外科臨床雜志, 2005, 12(5):346-349.
8. 卞曉明. 心房顫動的外科治療策略. 醫學與哲學, 2009, 30(4):16-19.
9. 武忠, 陳保俊, 曹彬, 等. 心內直視下射頻消融改良迷宮術治療心房顫動.中國胸心血管外科臨床雜志, 2007, 14(4):308-309.
10. 鄔曉臣, 張進寶, 歐陽輝, 等. 二尖瓣置換同期行雙極射頻消融術治療風濕性二尖瓣病變合并心房顫動的療效分析. 中國胸心血管外科臨床雜志, 2014, 21(6):827-829.
11. Lall SC, Melby SJ, Voeller RK, et al. The effect of ablation technology on surgical outcomes after the Cox-maze procedure:a propensity analysis. J Thorac Cardiovasc Surg, 2007, 133(2):3893-3896.
12. 劉健, 黃擊修, 林小彬, 等. 不阻斷升主動脈下直視雙極射頻消融治療心房顫動. 中國胸心血管外科臨床雜志, 2010, 17(5):425-427.
13. 姜兆磊, 梅舉, 馬南, 等. 新型改良心外射頻消融術治療主動脈瓣病變合并心房顫動的療效分析. 中國胸心血管外科臨床雜志, 2015, 22(8):725-728.
14. 程偉, 肖穎彬, 陳林, 等. 胸骨下段切口心臟不停跳技術在二尖瓣置換術中的應用. 中國胸心血管外科臨床雜志, 2013, 20(1):33-37.
15. Bonchek LI, Burlingme MW, Vazales BE, et al. Applicability of noncardioplegic coronary bypass to high-risk patients. Selection of patients, technique and clinical experience in 3000 patients. J Thorac Cardiovasc Surg, 1992, 103 (2):230-237.
16. Grrola LR, Olivereira SA, Moreira LP, et al. Blood cardioplegia with warm reperfusion versus intermittent aortic cross clamping in myocardial revascularization:randomized controlled trial. J Thorac Cardiovasc Surg, 1993, 106(3):491-496.
17. Louagie Y, Buche M, Eucher JC, et al. Improved patient survival withconcomitant cox maze Ⅲ procedure compared with heart surgery alone. Ann Thorac Surg, 2009, 87(2):440-446.
18. 王巍, 安君, 楊岷, 等. 二尖瓣置換術中射頻消融治療慢性心房顫動的療效分析. 中國胸心血管外科臨床雜志, 2013, 20(6):664-668.
19. Gillinov AM. Advances in surgical treatment of atrial fibrillation. Stroke, 2007, 38(2 Suppl):618-623.
20. Beukema WP, Sie HT, Misier AR, et al. Intermediate to long term results of radiofrequency modified maze procedure as an adjunct to open-heart surgery. Ann Thorac Surg, 2008, 86(5):1409-1414.
21. 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.
22. 張大國, 劉秀倫, 范壽年, 等. 換瓣術中單極和雙極射頻消融治療風濕性心臟病合并心房纖顫的臨床研究. 重慶醫學, 2012, 41(11):1115-1117.
23. Oueida F, Elawady MA, Eskander K, et al. Radiofrequency ablation of atrial fibrillation during mitral valve surgery. Asian Cardiovasc Thorac Ann. 2014, 14(3):210-218.
24. 王輝山, 汪曾煒, 李新民, 等. 雙極射頻消融迷宮術后同步電復律治療心房顫動. 中國胸心血管外科臨床雜志, 2011, 18(4):359-361.
25. Cox JL, Ad N, Palazzo T, et al. Current status of the Maze procedurefor the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg, 2000, 12(1):15-19.
26. Gillinov AM, Wolf RK. Surgical ablation of atrial fibrillation. Prog Cardiovasc Dis, 2005, 48(3):169-177.
27. Pasic M, Bergs P, Müller P, et al. Intraoperative radiofrequency maze ablation for atrial fibrillation:the Berlin modification. Ann Thorac Surg, 2001, 72(5): 1484-1490.
28. Geidel S, Ostermeyer J, Lass M, et al. Three years experience with monopolar and bipolar radiofrequeney ablation surgery in patients with permanent atrial fibrillation. Eur J Cardiothorae Surg, 2005, 27(2):243-249.
29. Dunninga J, Nagendranb M, Alfieric OR, et al. EACTS guideline for the surgical treatment of atrial fibrillation. Eur J Cardiothorac Surg, 2013, 44(5):777-791.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Analysis of Cardiac Surgery Concomitant with Bipolar Radiofrequency Ablation for Atrial Fibrillation

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