Novel Modified Epicardial Radiofrequency Ablation for Preoperative Atrial Fibrillation Combined with Aortic Valve Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGZhao-lei ,  MEIJu , MANan , TANGMin , DINGFang-bao , BAOChun-rong , HEYi , YINHang

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding author：

MEIJu, Email: ju_mei63@126.com

Keywords：

Atrial fibrillation; Radiofrequency ablation; Aortic valve disease

DOI：

10.7507/1007-4848.20150182

Video：

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Objective To assess the effect of a novel modified epicardial radiofrequency (RF) ablation for preoperative atrial fibrillation (AF) combined with aortic valve disease. Methods We retrospectively analyzed the clinical data of 28 patients with AF and aortic valve disease underwent the novel modified epicardial RF ablation combined with aortic valve replacement (AVR) in our hospital between December 2009 and December 2014. There were 18 males and 10 females at age of 53-73 (64.9±4.8) years. The patients were performed epicardial atrial fibrillation RF ablation plus aortic valve replacement. Results The modified epicardial RF ablation and AVR were performed successfully in all the patients. The maintenance of sinus rhythm was 96.4% (27/28) at discharge. There were no early death and permanent pacemaker implantation in perioperation. At a mean following-up of 29.2±17.7 months, 26 of 28 (92.9%) patients were in sinus rhythm. Following-up transthoracic echocardiography(TTE) at 6 months postoperatively showed that left atrial diameter was significantly reduced and left ventricular ejection fraction was significantly increased. Conclusion The novel modified epicardial RF ablation procedure is safe, feasible, and effective. It may be useful in selecting the best ablation approaches for patients with AF and aortic valve disease.

Citation： JIANGZhao-lei, MEIJu, MANan, TANGMin, DINGFang-bao, BAOChun-rong, HEYi, YINHang. Novel Modified Epicardial Radiofrequency Ablation for Preoperative Atrial Fibrillation Combined with Aortic Valve Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(8): 725-728. doi: 10.7507/1007-4848.20150182 Copy

1.	Go AS, Hylek EM, Phillips KA. Prevalence of diagnosed atrial fibrillation in adults:national implications for rhythm management and stroke prevention:the anticoagulation and risk factors in atrial fibrillation (atria) study. JAMA, 2001, 285:2370-2375.
2.	Zoni-Berisso M, Lercari F, Carazza T, et al. Epidemiology of atrial fibrillation:European perspective. Clin Epidemiol, 2014, 16(6):213-220.
3.	Wang X, Wang X, Song Y, et al. Efficiency of radiofrequency ablation for surgical treatment of chronic atrial fibrillation in rheumatic valvular disease. Int J Cardiol, 2014, 174(3):497-502.
4.	Abreu Filho CA, Lisboa LA, Dallan LA, et al. Effectiveness of the maze procedure using cooled-tip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease. Circulation, 2005, 112(9 Suppl):I20-I25.
5.	Caldwell JC, Mamas MA. Heart failure, diastolic dysfunction and atrial fibrillation; mechanistic insight of a complex interrelationship. Heart Fail Rev, 2010, 17:27-33.
6.	Widgren V, Dencker M, Juhlin T, et al. Aortic stenosis and mitral regurgitation as predictors of atrial fibrillation during 11 years of follow-up. BMC Cardiovasc Disord, 2012, 12:92.
7.	Cox JL. A brief overview of surgery for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1):80-88.
8.	Pinho-Gomes AC, Amorim MJ, Oliveira SM, et al. Surgical treatment of atrial fibrillation:an updated review. Eur J Cardiothorac Surg, 2014, 46(2):167-178.
9.	Nardi P, Mve Mvondo C, Scafuri A, et al. Left atrial radiofrequency ablation associated with valve surgery:midterm outcomes. Thorac Cardiovasc Surg, 2013, 61(5):392-397.
10.	Cox JL, Schuessler RB, D'Agostino HJ Jr, et al. The surgical treatment of atrial fibrillation. Ⅲ. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg, 1991, 101(4):569-583.
11.	Garcia-Villarreal OA, Fernández-Ceseña E, Vega-Hernández R. Cox maze Ⅲ procedure:the best alternative in surgery for atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 148(1):368-369.
12.	Weimar T, Bailey MS, Watanabe Y, et al. The Cox-maze Ⅳ procedure for lone atrial fibrillation:a single center experience in 100 consecutive patients. J Interv Card Electrophysiol, 2011, 31(1):47-54.
13.	Lawrance CP, Henn MC, Miller JR, et al. Comparison of the standalone Cox-Maze Ⅳ procedure to the concomitant Cox-Maze Ⅳ and mitral valve procedure for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1):55-61.
14.	Okada S, Weimar T, Moon MR, et al. The impact of previous catheterbased ablation on the efficacy of the Cox-maze Ⅳ procedure. Ann Thorac Surg, 2013, 96(3):786-791.
15.	Edgerton JR, Jackman WM, Mack MJ. A new epicardial lesion set for minimal access left atrial maze:the Dallas lesion set. Ann Thorac Surg, 2009, 88(5):1655-1657.
16.	Edgerton JR, Jackman WM, Mahoney C, et al. Totally thorascopic surgical ablation of persistent AF and long-standing persistent atrial fibrillation using the "Dallas" lesion set. Heart Rhythm, 2009, 6(12 Suppl):S64-S70.
17.	Jiang Z, Ma N, Tang M, et al. Effect of novel modified bipolar radiofrequency ablation for preoperative atrial fibrillation combined with off-pump coronary artery bypass grafting surgery. Heart Vessels, 2014 May 13.[Epub ahead of print]. DOI:10.1007/s00380-014-0519-2.
18.	姜兆磊, 梅举, 马南, 等. 双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究. 中国胸心血管外科临床杂志, 2014, 21(3):296-301.
19.	姜兆磊, 梅举, 丁芳宝, 等. 二尖瓣手术同期双心房与左心房心房颤动射频消融效果对比. 中华胸心血管外科杂志, 2014, 30(8):482-485.
20.	Mei J, Ma N, Ding F, et al. Complete thoracoscopic ablation of the left atrium via the left chest for treatment of lone atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 147(1):242-246.

1. Go AS, Hylek EM, Phillips KA. Prevalence of diagnosed atrial fibrillation in adults:national implications for rhythm management and stroke prevention:the anticoagulation and risk factors in atrial fibrillation (atria) study. JAMA, 2001, 285:2370-2375.
2. Zoni-Berisso M, Lercari F, Carazza T, et al. Epidemiology of atrial fibrillation:European perspective. Clin Epidemiol, 2014, 16(6):213-220.
3. Wang X, Wang X, Song Y, et al. Efficiency of radiofrequency ablation for surgical treatment of chronic atrial fibrillation in rheumatic valvular disease. Int J Cardiol, 2014, 174(3):497-502.
4. Abreu Filho CA, Lisboa LA, Dallan LA, et al. Effectiveness of the maze procedure using cooled-tip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease. Circulation, 2005, 112(9 Suppl):I20-I25.
5. Caldwell JC, Mamas MA. Heart failure, diastolic dysfunction and atrial fibrillation; mechanistic insight of a complex interrelationship. Heart Fail Rev, 2010, 17:27-33.
6. Widgren V, Dencker M, Juhlin T, et al. Aortic stenosis and mitral regurgitation as predictors of atrial fibrillation during 11 years of follow-up. BMC Cardiovasc Disord, 2012, 12:92.
7. Cox JL. A brief overview of surgery for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1):80-88.
8. Pinho-Gomes AC, Amorim MJ, Oliveira SM, et al. Surgical treatment of atrial fibrillation:an updated review. Eur J Cardiothorac Surg, 2014, 46(2):167-178.
9. Nardi P, Mve Mvondo C, Scafuri A, et al. Left atrial radiofrequency ablation associated with valve surgery:midterm outcomes. Thorac Cardiovasc Surg, 2013, 61(5):392-397.
10. Cox JL, Schuessler RB, D'Agostino HJ Jr, et al. The surgical treatment of atrial fibrillation. Ⅲ. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg, 1991, 101(4):569-583.
11. Garcia-Villarreal OA, Fernández-Ceseña E, Vega-Hernández R. Cox maze Ⅲ procedure:the best alternative in surgery for atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 148(1):368-369.
12. Weimar T, Bailey MS, Watanabe Y, et al. The Cox-maze Ⅳ procedure for lone atrial fibrillation:a single center experience in 100 consecutive patients. J Interv Card Electrophysiol, 2011, 31(1):47-54.
13. Lawrance CP, Henn MC, Miller JR, et al. Comparison of the standalone Cox-Maze Ⅳ procedure to the concomitant Cox-Maze Ⅳ and mitral valve procedure for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1):55-61.
14. Okada S, Weimar T, Moon MR, et al. The impact of previous catheterbased ablation on the efficacy of the Cox-maze Ⅳ procedure. Ann Thorac Surg, 2013, 96(3):786-791.
15. Edgerton JR, Jackman WM, Mack MJ. A new epicardial lesion set for minimal access left atrial maze:the Dallas lesion set. Ann Thorac Surg, 2009, 88(5):1655-1657.
16. Edgerton JR, Jackman WM, Mahoney C, et al. Totally thorascopic surgical ablation of persistent AF and long-standing persistent atrial fibrillation using the "Dallas" lesion set. Heart Rhythm, 2009, 6(12 Suppl):S64-S70.
17. Jiang Z, Ma N, Tang M, et al. Effect of novel modified bipolar radiofrequency ablation for preoperative atrial fibrillation combined with off-pump coronary artery bypass grafting surgery. Heart Vessels, 2014 May 13.[Epub ahead of print]. DOI:10.1007/s00380-014-0519-2.
18. 姜兆磊, 梅举, 马南, 等. 双心房或单纯右心房射频消融术治疗成人先天性心脏病房间隔缺损合并心房颤动的对比研究. 中国胸心血管外科临床杂志, 2014, 21(3):296-301.
19. 姜兆磊, 梅举, 丁芳宝, 等. 二尖瓣手术同期双心房与左心房心房颤动射频消融效果对比. 中华胸心血管外科杂志, 2014, 30(8):482-485.
20. Mei J, Ma N, Ding F, et al. Complete thoracoscopic ablation of the left atrium via the left chest for treatment of lone atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 147(1):242-246.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Novel Modified Epicardial Radiofrequency Ablation for Preoperative Atrial Fibrillation Combined with Aortic Valve Disease

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