Clinical Analysis of Concomitant Mitral Valve Replacement and Bipolar Radiofrequency Ablation for Chronic AtrialFibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Wei , AN Jun , YANG Min , FAN Jidan , FU Peng , HE Fengpu.

1. Department of CardiacSurgery，Subei People’s Hospital，Clinical College of Yangzhou University，Yangzhou 225001，Jiangsu，P. R. China;;
;;
2. Department of Cardiac Surgery，the Fifth Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，P. R. China;

Corresponding author：

Keywords：

Atrial fibrillation; 　Atricure bipolar radiofrequency system; 　Modified maze procedure; 　Mitral valve

DOI：

10.7507/1007-4848.20130207

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate clinical results of concomitant mitral valve replacement （MVR） and modified maze procedure with Atricure bipolar radiofrequency for chronic atrial fibrillation （AF）. Methods Clinical data of 59 patients with mitral valve diseases and chronic AF who underwent concomitant MVR and bipolar radiofrequency ablation in Subei People’s Hospital from June 2010 to September 2012 were retrospectively analyzed. There were 22 male and 37 female patients with their age of 29-71 （48±11） years. The AF duration was 1.2-26.0 （7.2±3.4） years. Preoperatively，there were 20 patients with New York Heart Association （NYHA） class Ⅱ，31 patients with NYHA class Ⅲ and 8 patients with NYHA class Ⅳ. There were 32 patients with moderate to severe mitral stenosis，9 patients with moderate to severe mitral regurgitation and 18 patients with combined mitral stenosis and regurgitation. There were 42 patients with tricuspid regurgitation. The left artial dimension was 39-98 （55.2±8.9） mm. Left atrial thrombus was found in 9 patients. Atricure bipolar radiofrequency system was used for right atrial ablation under normothermic cardiopulmonary bypass （CPB） with beating heart first，then for ablations of the left and right pulmonary vein orifices and left atrium under moderate hypothermia with heart arrest. MVR was performed after ablation procedures were completed. Amiodarone was routinely used postoperatively and patients were periodically followed up after discharge. Results There was no in-hospital death. CPB time was 65-180 （99±28）minutes，aortic cross-clamping time was 46-123 （69±17）minutes，and ablation time was 15-28 （21±4）minutes. Postoperatively，heart rhythm immediately changed to sinus rhythm （SR） in 44 patients，remained AF in 10 patients and atrial flutter in 1 patient. Temporary pacemaker was used for 4 patients with bradycardia （3 patients recovered SR and 1 patient remained AF later）. Fifty-eight patients were followed up after discharge for 6-33 months，and 1 patient was lost during follow-up. Patients’ SR rate was 86.2 % （50/58），91.4% （53/58），89.7 % （52/58），84.6 % （33/39）and 71.4 % （5/7）at discharge，3 months，6 months，1 year and 2 years after discharge respectively. There was no thrombotic event during follow-up. Conclusion Concomitant MVR and modified maze procedure with Atricure bipolar radiofrequency is a safe procedure for chronic AF with good short-term results.

Citation： WANG Wei,AN Jun,YANG Min,FAN Jidan,FU Peng,HE Fengpu.. Clinical Analysis of Concomitant Mitral Valve Replacement and Bipolar Radiofrequency Ablation for Chronic AtrialFibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(6): 664-668. doi: 10.7507/1007-4848.20130207 Copy

1.	李莉. 心房颤动外科治疗十年回顾. 中华心律失常学杂志， 2008， 12 （增刊1）：31-35.
2.	Wijffels MC， Kirchhof CJ， Dorland R， et al. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation， 1995， 92 （7）：1954-1968.
3.	Yanagawa B， Holmes SD， Henry L， et al. Outcome of concomitantCox-maze III procedure using an argon-based cryosurgical system：a single-center experience with 250 patients. Ann Thorac Surg， 2013， 95 （5）：1633-1639.
4.	Gillinov AM， McCarthy PM.Advances in the surgical treatment of atrial fibrillation. Cardiol Clin， 2004， 22 （1）：147-157.
5.	Cox JL， Schuessler RB， D’Agostino HJ Jr， et al. The surgical treatment of atrial fibrillation. III. Development of adefinitive surgical procedure. J Thorac Cardiovasc Surg， 1991， 101 （4）：569-583.
6.	Cox JL， Jaquiss RD， Schuessler RB， et al. Modification of the mazeprocedure for atrial flutter and atrial fibrillation . Ⅱ. Surgical techniqueof the mazeⅢprocedure. J Thorac Cardiovasc Surg， 1995， 110 （2）：485-495.
7.	Sueda T， Nagata H， Orihashi K， et al. Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations. Ann Thorac Surg， 1997， 63 （4）：1070-1075.
8.	Kim JB， Ju MH， Yun SC. Mitral valve replacement with or without a concomitant Maze procedure in patients with atrial fibrillation. Heart， 2010， 96 （14）：1126-1131.
9.	Kim KC， Cho KR， Kim YJ， et al. Long-term results of the Cox mazeⅢprocedure for persistent atrial fibrillation associated with rheumatic mitral valve disease：10-year experience. Eur J Cardiothorac Surg， 2007， 31 （2）：261-266.
10.	陈如坤，陈勇兵，王永清，等. 风湿性二尖瓣病变伴房颤的外科治疗. 中华胸心血管外科杂志， 2002， 18 （5）：264-266.
11.	Benussi S， Pappone C， Nascimbene S， et al. A simple way to treat chronic atrial fibrillation during mitral valve surgery：the epicardial radiofrequency approach. Eur J Cardiothorac Surg， 2000， 17 （5）：524-529.
12.	Robertson JO， Lawrance CP， Maniar HS， et al. Surgical techniques used for the treatment of atrial fibrillation. Circ J， 2013， 77 （8）：1941-1951.
13.	Mohr FW， Fabricius AM， Falk V， et al. Curative treatment of atrial fibrillation with intraoperative radiofrequency ablation：short-term and midterm results. J Thorac Cardiovasc Surg， 2002， 123 （5）：919-927.
14.	Deneke T， Khargi K， Müller KM， et al. Histopathology of intraoperatively induced linear radiofrequency ablation lesions in patients with chronic atrial fibrillation. Eur Heart J， 2005， 26 （17）：1797-1803.
15.	Voeller RK， Zierer A， Lall SC， et al. Efficacy of a novel bipolar radiofrequency ablation device on the beating heart for atrial fibrillationablation：a long-term porcine study. J Thorac Cardiovasc Surg， 2010，140 （1）：203-208.
16.	Albåge A， Jidéus L， Ståhle E， et al. Early and long-term mortality in 536 patients after the Cox-maze III procedure：a national registry-based study. Ann Thorac Surg， 2013， 95 （5）：1626-1632.
17.	Sie HT， Beukemam WP， Ramdal MR， et al. The radiofrequency modified maze procedure. A less invasive surgical approach to atrial fibrillation during open heart surgery. Eur J Cardiaothorac Surg， 2001， 19 （4）：443-447.
18.	姚建民，赵向东，肖志斌，等. 直视双极射频消融术治疗心瓣膜病合并慢性心房颤动. 中国胸心血管外科临床杂志， 2009， 16 （4）：315-316.
19.	Choi JB， Park HK， Kim KH， et al. Predictive factors of sustained sinus rhythm and recurrent atrial fibrillation after the maze procedure. Korean J Thorac Cardiovasc Surg， 2013， 46 （2）：117-123.
20.	Beukema WP， Sie HT， Misier AR， et al. Predictive factors of sust-ained sinus rhythm and recurrent atrial fibrillation after a radiofrequ-ency modified Maze procedure. Eur J Cardiothorac Surg， 2008， 34 （4）：771-775.
21.	Avitall B， Urbonas A， Urboniene D， et al. Linear lesions provide protection from atrial fibrillation induction with rapid atrial pacing. J Cardiovasc Electrophysiol， 2002， 13 （5）：455-462.
22.	Kobayashi T， Komiya T， Tamura N， et al. Long-term result of the maze procedure for atrial fibrillation. Kyobu Geka， 2010， 63 （4）：271-275.
23.	Nakamura T， Izutani H， Sawa Y. Mid-term outcomes of the modifiedCox-maze procedure for elderly patients：a risk analysis for failure. Interact Cardiovasc Thorac Surg， 2011， 12 （6）：924-928.
24.	李菲，孟旭. 术前左心房内径对外科射频消融术治疗心房颤动疗效的影响. 中国胸心血管外科临床杂志， 2013， 20 （1）：38-42.
25.	陈光献，唐白云，张希，等. 心瓣膜置换术同期双极射频消融治疗心房颤动. 中国胸心血管外科临床杂志， 2010， 17 （1）：65-67.
26.	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.
27.	Deneke T， Khargi K， Grewe PH， et al. Left atrial versus bi-atrial Maze operation using intraoperatively cooled-tip radiofrequency ablation in patients undergoing open-heart surgery：safety and efficacy. J Am Coll Cardiol， 2002， 39 （10）：1644-1650.
28.	Albrecht A， Kalil RA， Schuch L， et al. Randomized study of surgicalisolation of the pulmonary veins for correction of permanent atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg， 2009， 138 （2）：454-459.

1. 　李莉. 心房颤动外科治疗十年回顾. 中华心律失常学杂志， 2008， 12 （增刊1）：31-35.
2. 　Wijffels MC， Kirchhof CJ， Dorland R， et al. Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation， 1995， 92 （7）：1954-1968.
3. 　Yanagawa B， Holmes SD， Henry L， et al. Outcome of concomitantCox-maze III procedure using an argon-based cryosurgical system：a single-center experience with 250 patients. Ann Thorac Surg， 2013， 95 （5）：1633-1639.
4. 　Gillinov AM， McCarthy PM.Advances in the surgical treatment of atrial fibrillation. Cardiol Clin， 2004， 22 （1）：147-157.
5. 　Cox JL， Schuessler RB， D’Agostino HJ Jr， et al. The surgical treatment of atrial fibrillation. III. Development of adefinitive surgical procedure. J Thorac Cardiovasc Surg， 1991， 101 （4）：569-583.
6. 　Cox JL， Jaquiss RD， Schuessler RB， et al. Modification of the mazeprocedure for atrial flutter and atrial fibrillation . Ⅱ. Surgical techniqueof the mazeⅢprocedure. J Thorac Cardiovasc Surg， 1995， 110 （2）：485-495.
7. 　Sueda T， Nagata H， Orihashi K， et al. Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations. Ann Thorac Surg， 1997， 63 （4）：1070-1075.
8. 　Kim JB， Ju MH， Yun SC. Mitral valve replacement with or without a concomitant Maze procedure in patients with atrial fibrillation. Heart， 2010， 96 （14）：1126-1131.
9. 　Kim KC， Cho KR， Kim YJ， et al. Long-term results of the Cox mazeⅢprocedure for persistent atrial fibrillation associated with rheumatic mitral valve disease：10-year experience. Eur J Cardiothorac Surg， 2007， 31 （2）：261-266.
10. 　陈如坤，陈勇兵，王永清，等. 风湿性二尖瓣病变伴房颤的外科治疗. 中华胸心血管外科杂志， 2002， 18 （5）：264-266.
11. 　Benussi S， Pappone C， Nascimbene S， et al. A simple way to treat chronic atrial fibrillation during mitral valve surgery：the epicardial radiofrequency approach. Eur J Cardiothorac Surg， 2000， 17 （5）：524-529.
12. 　Robertson JO， Lawrance CP， Maniar HS， et al. Surgical techniques used for the treatment of atrial fibrillation. Circ J， 2013， 77 （8）：1941-1951.
13. 　Mohr FW， Fabricius AM， Falk V， et al. Curative treatment of atrial fibrillation with intraoperative radiofrequency ablation：short-term and midterm results. J Thorac Cardiovasc Surg， 2002， 123 （5）：919-927.
14. 　Deneke T， Khargi K， Müller KM， et al. Histopathology of intraoperatively induced linear radiofrequency ablation lesions in patients with chronic atrial fibrillation. Eur Heart J， 2005， 26 （17）：1797-1803.
15. 　Voeller RK， Zierer A， Lall SC， et al. Efficacy of a novel bipolar radiofrequency ablation device on the beating heart for atrial fibrillationablation：a long-term porcine study. J Thorac Cardiovasc Surg， 2010，140 （1）：203-208.
16. 　Albåge A， Jidéus L， Ståhle E， et al. Early and long-term mortality in 536 patients after the Cox-maze III procedure：a national registry-based study. Ann Thorac Surg， 2013， 95 （5）：1626-1632.
17. 　Sie HT， Beukemam WP， Ramdal MR， et al. The radiofrequency modified maze procedure. A less invasive surgical approach to atrial fibrillation during open heart surgery. Eur J Cardiaothorac Surg， 2001， 19 （4）：443-447.
18. 　姚建民，赵向东，肖志斌，等. 直视双极射频消融术治疗心瓣膜病合并慢性心房颤动. 中国胸心血管外科临床杂志， 2009， 16 （4）：315-316.
19. 　Choi JB， Park HK， Kim KH， et al. Predictive factors of sustained sinus rhythm and recurrent atrial fibrillation after the maze procedure. Korean J Thorac Cardiovasc Surg， 2013， 46 （2）：117-123.
20. 　Beukema WP， Sie HT， Misier AR， et al. Predictive factors of sust-ained sinus rhythm and recurrent atrial fibrillation after a radiofrequ-ency modified Maze procedure. Eur J Cardiothorac Surg， 2008， 34 （4）：771-775.
21. 　Avitall B， Urbonas A， Urboniene D， et al. Linear lesions provide protection from atrial fibrillation induction with rapid atrial pacing. J Cardiovasc Electrophysiol， 2002， 13 （5）：455-462.
22. 　Kobayashi T， Komiya T， Tamura N， et al. Long-term result of the maze procedure for atrial fibrillation. Kyobu Geka， 2010， 63 （4）：271-275.
23. 　Nakamura T， Izutani H， Sawa Y. Mid-term outcomes of the modifiedCox-maze procedure for elderly patients：a risk analysis for failure. Interact Cardiovasc Thorac Surg， 2011， 12 （6）：924-928.
24. 　李菲，孟旭. 术前左心房内径对外科射频消融术治疗心房颤动疗效的影响. 中国胸心血管外科临床杂志， 2013， 20 （1）：38-42.
25. 　陈光献，唐白云，张希，等. 心瓣膜置换术同期双极射频消融治疗心房颤动. 中国胸心血管外科临床杂志， 2010， 17 （1）：65-67.
26. 　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.
27. 　Deneke T， Khargi K， Grewe PH， et al. Left atrial versus bi-atrial Maze operation using intraoperatively cooled-tip radiofrequency ablation in patients undergoing open-heart surgery：safety and efficacy. J Am Coll Cardiol， 2002， 39 （10）：1644-1650.
28. 　Albrecht A， Kalil RA， Schuch L， et al. Randomized study of surgicalisolation of the pulmonary veins for correction of permanent atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg， 2009， 138 （2）：454-459.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Analysis of Concomitant Mitral Valve Replacement and Bipolar Radiofrequency Ablation for Chronic AtrialFibrillation

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content