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.	王坚刚, 孟旭, 李晖, 等. 心内膜合并心外膜改良迷宫射频消融治疗心房纤颤. 中华外科杂志, 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.	刘泓, 肖颖彬, 陈林, 等. 瓣膜置换同期双极射频消融术对心功能恢复的影响. 中国胸心血管外科临床杂志, 2015, 22(5):428-433.
7.	侯迈. 心房颤动的外科治疗. 中国胸心血管外科临床杂志, 2005, 12(5):346-349.
8.	卞晓明. 心房颤动的外科治疗策略. 医学与哲学, 2009, 30(4):16-19.
9.	武忠, 陈保俊, 曹彬, 等. 心内直视下射频消融改良迷宫术治疗心房颤动.中国胸心血管外科临床杂志, 2007, 14(4):308-309.
10.	邬晓臣, 张进宝, 欧阳辉, 等. 二尖瓣置换同期行双极射频消融术治疗风湿性二尖瓣病变合并心房颤动的疗效分析. 中国胸心血管外科临床杂志, 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.	刘健, 黄击修, 林小彬, 等. 不阻断升主动脉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.
13.	姜兆磊, 梅举, 马南, 等. 新型改良心外射频消融术治疗主动脉瓣病变合并心房颤动的疗效分析. 中国胸心血管外科临床杂志, 2015, 22(8):725-728.
14.	程伟, 肖颖彬, 陈林, 等. 胸骨下段切口心脏不停跳技术在二尖瓣置换术中的应用. 中国胸心血管外科临床杂志, 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, 杨岷, 等. 二尖瓣置换术中射频消融治疗慢性心房颤动的疗效分析. 中国胸心血管外科临床杂志, 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.	杨嵩, 张希, 唐白云, 等. 永久性心房颤动外科双极射频消融术的效果. 中国胸心血管外科临床杂志, 2012, 19(3):254-257.
22.	张大国, 刘秀伦, 范寿年, 等. 换瓣术中单极和双极射频消融治疗风湿性心脏病合并心房纤颤的临床研究. 重庆医学, 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.	王辉山, 汪曾炜, 李新民, 等. 双极射频消融迷宫术后同步电复律治疗心房颤动. 中国胸心血管外科临床杂志, 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. 王坚刚, 孟旭, 李晖, 等. 心内膜合并心外膜改良迷宫射频消融治疗心房纤颤. 中华外科杂志, 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. 刘泓, 肖颖彬, 陈林, 等. 瓣膜置换同期双极射频消融术对心功能恢复的影响. 中国胸心血管外科临床杂志, 2015, 22(5):428-433.
7. 侯迈. 心房颤动的外科治疗. 中国胸心血管外科临床杂志, 2005, 12(5):346-349.
8. 卞晓明. 心房颤动的外科治疗策略. 医学与哲学, 2009, 30(4):16-19.
9. 武忠, 陈保俊, 曹彬, 等. 心内直视下射频消融改良迷宫术治疗心房颤动.中国胸心血管外科临床杂志, 2007, 14(4):308-309.
10. 邬晓臣, 张进宝, 欧阳辉, 等. 二尖瓣置换同期行双极射频消融术治疗风湿性二尖瓣病变合并心房颤动的疗效分析. 中国胸心血管外科临床杂志, 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. 刘健, 黄击修, 林小彬, 等. 不阻断升主动脉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.
13. 姜兆磊, 梅举, 马南, 等. 新型改良心外射频消融术治疗主动脉瓣病变合并心房颤动的疗效分析. 中国胸心血管外科临床杂志, 2015, 22(8):725-728.
14. 程伟, 肖颖彬, 陈林, 等. 胸骨下段切口心脏不停跳技术在二尖瓣置换术中的应用. 中国胸心血管外科临床杂志, 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, 杨岷, 等. 二尖瓣置换术中射频消融治疗慢性心房颤动的疗效分析. 中国胸心血管外科临床杂志, 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. 杨嵩, 张希, 唐白云, 等. 永久性心房颤动外科双极射频消融术的效果. 中国胸心血管外科临床杂志, 2012, 19(3):254-257.
22. 张大国, 刘秀伦, 范寿年, 等. 换瓣术中单极和双极射频消融治疗风湿性心脏病合并心房纤颤的临床研究. 重庆医学, 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. 王辉山, 汪曾炜, 李新民, 等. 双极射频消融迷宫术后同步电复律治疗心房颤动. 中国胸心血管外科临床杂志, 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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