Combined Off-pump Coronary Artery Bypass Grafting and Bipolar Radiofrequency Ablation for Atrial Fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONGShi-qiu , ZHANGJian-qun ,  XIEJin-sheng , BOPing , CAOXiang-rong , WANGSheng-xun , YANGChuan-rui

Department of Cardiac Surgery, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing 100029, P. R. China;

Corresponding author：

XIEJin-sheng, Email: shoe666@sohu.com

Keywords：

Coronary artery disease; Atrial fibrillation; Off-pump coronary artery bypass grafting; Radiofrequency ablation

DOI：

10.7507/1007-4848.20140215

Video：

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Objective To evaluate surgical outcomes of combined off-pump coronary artery bypass grafting (OPCAB)and bipolar radiofrequency ablation (RFA)for atrial fibrillation (AF). Methods From January 2008 to October 2013, 49 patients with coronary artery disease and AF underwent OPCAB and concomitant Atricure bipolar RFA for AF in Beijing Anzhen Hospital. According to their AF duration, all the 49 patients were divided into 2 groups. In group A, there were 14 patients with permanent AF including 9 males and 5 females with their age of 56.7±7.5 years. In group B, there were 35 patients with paroxysmal AF including 27 males and 8 females with their age of 60.2±10.5 years. AF duration was 9.4±6.0 months. Coronary artery stenosis was 85%-100%. Ambulatory electrocardiogram and echocardiography were performed to observe AF recurrence during follow-up. Results None of the patients received intraoperative conversion operation under cardiopulmonary bypass, and there was no in-hospital death. Postoperatively, 81.6% (40/49)patients had conversion to sinus rhythm (SR)or junctional rhythm, 18.4% (9/49)patients remained AF, but none of the patients had second or third-degree atrioventricular block. A total of 139 distal anastomoses were performed with a mean of 2.8 distal anastomoses per patient. Length of hospital stay was 10-15 (12±3)days. SR was observed in 34 patients (69%)before discharge including 9 patients (64%)in group A and 25 patients (71%)in group B. All the patients (100%)were followed up for 5-12 months. 39 patients (80%)maintained SR over 6 months, including 10 patients (71%)in group A and 29 patients (83%)in group B. 44 patients (90%)maintained SR over 12 months, including 11 patients (79%)in group A and 33 patients (94%)in group B. There was no statistical difference in SR maintenance rate between the 2 groups (P > 0.05). Conclusion OPCAB and concomitant bipolar RFA for AF is safe, efficacious and feasible.

Citation： SONGShi-qiu, ZHANGJian-qun, XIEJin-sheng, BOPing, CAOXiang-rong, WANGSheng-xun, YANGChuan-rui. Combined Off-pump Coronary Artery Bypass Grafting and Bipolar Radiofrequency Ablation for Atrial Fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 748-752. doi: 10.7507/1007-4848.20140215 Copy

1.	Pradhan R, Chaudhary A, Donato AA. Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease. Am J Emerg Med, 2012, 30(7):1042-1047.
2.	范萌, 李光日, 魏锋.不停跳下冠状动脉旁路移植术后新发房颤的处理经验.中国医药指南, 2012, 10(7):171.
3.	Nucifora G, Schuijf JD, van Werkhoven JM, et al. Relationship between obstructive coronary artery disease and abnormal stress testing in patients with paroxysmal or persistent atrial fibrillation. Int J Cardiovasc Imaging, 2011, 27(6):777-785.
4.	孟旭, 王坚刚.心内直视下射频消融术治疗心房纤颤.中华胸心血管外科杂志, 2005, 21(4):247-248.
5.	Pokushalov E, Romanov A, Corbucci G, et al. Benefit of ablation of first diagnosed paroxysmal atrial fibrillation during coronary artery bypass grafting:a pilot study. Eur J Cardiothorac Surg, 2012, 41(3):556-560.
6.	宋士秋, 张健群, 李温斌, 等.升主动脉隔离装置在升主动脉近端钙化患者非体外循环冠状动脉旁路移植术中的应用.中国胸心血管外科临床杂志, 2010, 17(2):158-160.
7.	刘健, 黄击修, 林小彬, 等.不中断冠脉循环下直视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(5):425-427.
8.	刘勇, 缪文强, 魏旎, 等.心脏手术同期Atricure双极射频消融治疗心房纤颤.广东医学, 2012, 33(21):3263-3264.
9.	赵强, 孙晓宁, 陈安清, 等.微创冠状动脉旁路移植术同时行双极消融治疗房颤.中国临床医学, 2008, 15(2):139-141.
10.	罗勇, 张力, 陈剑, 等.非体外循环下冠状动脉旁路移植术同期Atricure双极射频消融治疗冠心病合并心房颤动七例报道.中华临床医师杂志:电子版, 2012, 6(4):1049-1050.
11.	Kalavrouziotis D, Buth KJ, Vyas T, et al. Preoperative atrial fibrillation decreases event-free survival following cardiac surgery. Eur J Cardiothorac Surg, 2009, 36(2):293-299.
12.	Khargi K, Lemke B, Haardt H, et al. Concomitant anti-arrhythmic surgery, using irrigated cooled-tip radiofrequency ablation, to treat permanent atrial fibrillation in CABG patients:expansion of the indication? Eur J Cardiothorac Surg, 2004, 25(6):1018-1024.
13.	Gammie JS, Haddad M, Milford-Beland S, et al. Atrial fibrillation correction surgery:lessons from the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg, 2008, 85(3):909-914.
14.	FukharaK, Kotoh K, DoiT, et al. Impact of preoperative atrialfibrillation on the late outcome of off-pump coronary artery bypass surgery. Eur J Cadiothorac Surg, 2010, 38(3):366-372.
15.	Ad N, Henry L, Hunt S, et al. Do we increase the operative risk by adding the Cox Maze Ⅲ procedure to aortic valve replacement and coronary artery bypass surgery? J Thorac Cardiovasc Surg, 2012, 143(4):936-944.
16.	Ad N, Henry L, Friehling T, et al. Minimally invasive standalone cox-maze procedure for patients with nonparoxysmal atrial fibrillation. Ann Thorac Surg, 2013, 96(3):792-798.
17.	Sueda T, Nagata H, Shikata H, et al. Simple left atrial procedure for chronic atriaI fibrillation associated with mitraI valve disease. Ann Thorac Surg, 1996, 62(6):1796-1800.
18.	Ad N, Suri R M, Gammie JS, et al. Surgical ablation of atrial fibrillation trends and outcomes in North America. J Thorac Cardiovasc Surg, 2012, 144(5):1051-1060.
19.	张大国, 刘秀伦, 刘小斌, 等.瓣膜置换术中直视双极射频消融治疗风湿性心脏病心房纤颤70例.中华胸心血管外科杂志, 2011, 27(3):180-181.
20.	李军山, 郭志刚, 宋静华, 等. 22例冠状动脉旁路移植术同期双极射频消融治疗心房纤颤.中华临床医师杂志(电子版), 2012, 6(4):1049-1050.
21.	Henry L, Ad N. Performance of the Cox Maze procedure-a large surgical ablation center's experience. Ann Cardiothorac Surg, 2014, 3(1):62-69.
22.	于洋, 顾承雄, 李京倖, 等.非体外循环下采用自制二尖瓣成形装置手术治疗轻至中度缺血性二尖瓣关闭不全.中国胸心血管外科临床杂志, 2012, 19(3):244-247.
23.	Hwang C, Chen PS. Ligament of marshall:why it is important for atrial fibrillation ablation. Heart Rhythm, 2009, 6(12 Suppl):S35-S40.
24.	闫倩, 刘兴鹏, 李晖, 等.消融犬Marshall韧带对刺激心房左后脂肪垫所致心房颤动的影响及机制.中国心脏起搏与心电生理杂志, 2010, 24(1):48-52.
25.	谭海斌, 杨希立, 温旭涛.心房颤动经导管射频消融治疗发生的并发症及处理.中国心脏起搏与心电生理杂志, 2008, 22(5):451-453.
26.	Benussi S, Galanti A, Nascimbene S, et al. Complete right atrial ablation with bipolar radiofrequency. Ann Thorac Surg, 2009, 87(5):1573-1576.

1. Pradhan R, Chaudhary A, Donato AA. Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease. Am J Emerg Med, 2012, 30(7):1042-1047.
2. 范萌, 李光日, 魏锋.不停跳下冠状动脉旁路移植术后新发房颤的处理经验.中国医药指南, 2012, 10(7):171.
3. Nucifora G, Schuijf JD, van Werkhoven JM, et al. Relationship between obstructive coronary artery disease and abnormal stress testing in patients with paroxysmal or persistent atrial fibrillation. Int J Cardiovasc Imaging, 2011, 27(6):777-785.
4. 孟旭, 王坚刚.心内直视下射频消融术治疗心房纤颤.中华胸心血管外科杂志, 2005, 21(4):247-248.
5. Pokushalov E, Romanov A, Corbucci G, et al. Benefit of ablation of first diagnosed paroxysmal atrial fibrillation during coronary artery bypass grafting:a pilot study. Eur J Cardiothorac Surg, 2012, 41(3):556-560.
6. 宋士秋, 张健群, 李温斌, 等.升主动脉隔离装置在升主动脉近端钙化患者非体外循环冠状动脉旁路移植术中的应用.中国胸心血管外科临床杂志, 2010, 17(2):158-160.
7. 刘健, 黄击修, 林小彬, 等.不中断冠脉循环下直视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(5):425-427.
8. 刘勇, 缪文强, 魏旎, 等.心脏手术同期Atricure双极射频消融治疗心房纤颤.广东医学, 2012, 33(21):3263-3264.
9. 赵强, 孙晓宁, 陈安清, 等.微创冠状动脉旁路移植术同时行双极消融治疗房颤.中国临床医学, 2008, 15(2):139-141.
10. 罗勇, 张力, 陈剑, 等.非体外循环下冠状动脉旁路移植术同期Atricure双极射频消融治疗冠心病合并心房颤动七例报道.中华临床医师杂志:电子版, 2012, 6(4):1049-1050.
11. Kalavrouziotis D, Buth KJ, Vyas T, et al. Preoperative atrial fibrillation decreases event-free survival following cardiac surgery. Eur J Cardiothorac Surg, 2009, 36(2):293-299.
12. Khargi K, Lemke B, Haardt H, et al. Concomitant anti-arrhythmic surgery, using irrigated cooled-tip radiofrequency ablation, to treat permanent atrial fibrillation in CABG patients:expansion of the indication? Eur J Cardiothorac Surg, 2004, 25(6):1018-1024.
13. Gammie JS, Haddad M, Milford-Beland S, et al. Atrial fibrillation correction surgery:lessons from the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg, 2008, 85(3):909-914.
14. FukharaK, Kotoh K, DoiT, et al. Impact of preoperative atrialfibrillation on the late outcome of off-pump coronary artery bypass surgery. Eur J Cadiothorac Surg, 2010, 38(3):366-372.
15. Ad N, Henry L, Hunt S, et al. Do we increase the operative risk by adding the Cox Maze Ⅲ procedure to aortic valve replacement and coronary artery bypass surgery? J Thorac Cardiovasc Surg, 2012, 143(4):936-944.
16. Ad N, Henry L, Friehling T, et al. Minimally invasive standalone cox-maze procedure for patients with nonparoxysmal atrial fibrillation. Ann Thorac Surg, 2013, 96(3):792-798.
17. Sueda T, Nagata H, Shikata H, et al. Simple left atrial procedure for chronic atriaI fibrillation associated with mitraI valve disease. Ann Thorac Surg, 1996, 62(6):1796-1800.
18. Ad N, Suri R M, Gammie JS, et al. Surgical ablation of atrial fibrillation trends and outcomes in North America. J Thorac Cardiovasc Surg, 2012, 144(5):1051-1060.
19. 张大国, 刘秀伦, 刘小斌, 等.瓣膜置换术中直视双极射频消融治疗风湿性心脏病心房纤颤70例.中华胸心血管外科杂志, 2011, 27(3):180-181.
20. 李军山, 郭志刚, 宋静华, 等. 22例冠状动脉旁路移植术同期双极射频消融治疗心房纤颤.中华临床医师杂志(电子版), 2012, 6(4):1049-1050.
21. Henry L, Ad N. Performance of the Cox Maze procedure-a large surgical ablation center's experience. Ann Cardiothorac Surg, 2014, 3(1):62-69.
22. 于洋, 顾承雄, 李京倖, 等.非体外循环下采用自制二尖瓣成形装置手术治疗轻至中度缺血性二尖瓣关闭不全.中国胸心血管外科临床杂志, 2012, 19(3):244-247.
23. Hwang C, Chen PS. Ligament of marshall:why it is important for atrial fibrillation ablation. Heart Rhythm, 2009, 6(12 Suppl):S35-S40.
24. 闫倩, 刘兴鹏, 李晖, 等.消融犬Marshall韧带对刺激心房左后脂肪垫所致心房颤动的影响及机制.中国心脏起搏与心电生理杂志, 2010, 24(1):48-52.
25. 谭海斌, 杨希立, 温旭涛.心房颤动经导管射频消融治疗发生的并发症及处理.中国心脏起搏与心电生理杂志, 2008, 22(5):451-453.
26. Benussi S, Galanti A, Nascimbene S, et al. Complete right atrial ablation with bipolar radiofrequency. Ann Thorac Surg, 2009, 87(5):1573-1576.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Combined Off-pump Coronary Artery Bypass Grafting and Bipolar Radiofrequency Ablation for Atrial Fibrillation

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