Bi-polar radiofrequency ablation for rheumatic heart disease with atrial fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Jiasheng , ZHANG Bengui , XIAO Zhenghua , LIU Lulu ,  GUO Yingqiang

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

GUO Yingqiang, Email: drguoyq@hotmail.com

Keywords：

Rheumatic heart disease; atrial fibrillation; bio-polar radiofrequency ablation; quality of life

DOI：

10.7507/1007-4848.201701030

Video：

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Objective To evaluate the clinical effects of bi-polar radiofrequency ablation (BRFA) for the surgical treatment of atrial fibrillation (AF) in rheumatic heart disease (RHD) patients. Methods We involved 96 RHD patients who underwent valve replacement in Department of Cardiovascular Surgery, West China Hospital from July 2014 through May 2015. There were 74 patients with AF, 22 in sinus rhythm. All patients with AF were fully informed of BRFA, in which 40 of the 74 patients received while the other 34 patients refused. The 40 patients with AF who received BRFA were classified into a treatment group and the other 34 patients were classified into a control group. The 20 patients with sinus rhythm were classified into a blank group as well. The clinical effect and quality of life of the patients were analyzed. Results Left atrial diameter (LAD), pulmonary arterial systolic pressure (PASP), and conversion rate of sinus rhythm at discharge, maintenance rate of sinus rhythm during follow-up in patients with AF were significantly higher than those in the patients in sinus rhythm. No difference was found in terms of survival rate, mortality, major complications among the three groups. The treatment group experienced higher scores in physical functioning (PF), role-physical (RP), general health (GH), vitality (VT), social functioning (SF), mental health (MH), physical component summary (PCS), mental component summary(MCS) and total score compared with the control group both at postoperative 3-month and 6-month . At postoperative 12-month, the treatment group experienced higher scores in PF, RP, GH, PCS, and total score compared with the control group. Conclusion AF would enhance the negative impact on structure remodeling in RHD patients. BRFA is beneficial for the conversion and maintaining of sinus rhythm in RHD patients and the decreasing of LAD & PASP parameter as well. BRFA is more beneficial for the improvement of quality of life in RHD patients with AF during one-year follow-up.

Citation： LIU Jiasheng, ZHANG Bengui, XIAO Zhenghua, LIU Lulu, GUO Yingqiang. Bi-polar radiofrequency ablation for rheumatic heart disease with atrial fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(12): 923-931. doi: 10.7507/1007-4848.201701030 Copy

1.	Ball J, Carrington MJ, McMurray JJ, et al. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol, 2013, 167(5): 1807-1824.
2.	肖锡俊, 袁宏声, 唐红, 等. 二尖瓣置换时采用盐水冲洗的射频改良迷宫手术治疗心房颤动. 中华心律失常学杂志, 2006, 10(5): 342-334.
3.	Abo-Salem E, Lockwood D, Boersma L, et al. Surgical treatment of atrial fibrillation. J Cardiovasc Electrophysiol, 2015, 26(9): 1027-1037.
4.	Gillinov AM, Gelijns AC, Parides MK, et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med, 2015, 372(15): 1399-1409.
5.	Grönefeld GC, Hohnloser SH. Quality of life in atrial fibrillation: an increasingly important issue. Eur Heart J Suppl, 2003, 5(H): H25-H33.
6.	Rostagno C, Gelsomino S, Capecchi I, et al. Factors related to sinus rhythm at discharge after radiofrequency ablation of permanent atrial fibrillation in patients undergoing mitral valve surgery. Heart Vessels, 2016, 31(4): 593-598.
7.	Wolf PA, Benjamin EJ, Belanger AJ, et al. Secular trends in the prevalence of atrial fibrillation: the Framingham Study. Am Heart J, 1996, 131(4): 790-795.
8.	Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the An Ticoagulation and Risk Factors in Atrial Fibrillation(ATRIA) Study. JAMA, 2001, 285(18): 2370-2375.
9.	Nishimura RA, Carabello BA, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(23): 2440-2492.
10.	Voeller RK, Zierer A, Lall SC, et al. The effects of the Cox maze procedure on atrial function. J Thorac Cardiovasc Surg, 2008, 136(5): 1257-1264.
11.	Gandek B, Ware JE Jr. Methods for validating and norming translations of health status questionnaires: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol, 1998, 51(11): 953-959.
12.	魏朝晖, 莫一心. 生命质量测定量表 SF-36 的应用. 中国社会医学杂志, 1997, 14(4): 145-147.
13.	李宁秀, 刘朝杰, 李俊, 等. 四川省城乡居民 SF-36 评价参考值. 华西医大学报, 2001, 31(1): 43-47.
14.	Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Torac Cardiovasc Surg, 2012, 143(3): 632-638.
15.	January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol, 2014, 64(21): e1-e76.
16.	Kabukcu M, Arslantas E, Ates I, et al. Clinical, echocardiographic, and hemodynamic characteristics of rheumatic mitral valve stenosis and atrial fibrillation. Angiology, 2005, 56(2): 159-163.
17.	Abo-Salem E, Lockwood D, Boersma L, et al. Surgical treatment of atrial fibrillation. J Cardiovasc Electrophysiol, 2015, 26(9): 1027-1037.
18.	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 Heart Vasc, 2014, 174(3): 497-502.
19.	Loardi C, Alamanni F, Galli C, et al. Surgical treatment of concomitant atrial fibrillation: focus onto atrial contractility. Biomed Res Int, 2015, 2015: 274817.
20.	von Oppell UO, Masani N, O'Callaghan P, et al. Mitral valve surgery plus concomitant atrial fibrillation ablation is superior to mitral valve surgery alone with an intensive rhythm control strategy. Eur J Cardiothorac Surg, 2009, 35(4): 641-650.
21.	Zorlu A, Amioglu G, Yilmaz N, et al. The relationship between mean pulmonary artery pressure and quality of life in patients with mitral stenosis. Cardiology, 2011, 119(3): 170-175.
22.	Dorian P, Jung W, Newman D, et al. The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J Am Coll Cardiol, 2000, 36(4): 1303-1309.
23.	Aliot E, Botto GL, Crijns HJ, et al. Quality of life in patients with atrial fibrillation: how to assess it and how to improve it. Europace, 2014, 16(6): 787-796.
24.	Hagens VE, Ranchor AV, Van Sonderen E, et al. Effect of rate or rhythm control on quality of life in persistent atrial fibrillation.Results from the Rate Control Versus Electrical Cardioversion (RACE) Study. J Am Coll Cardiol, 2004, 43(2): 241-247.
25.	Van Breugel HN, Nieman FH, Accord RE, et al. A prospective randomized multicenter comparison on health-related quality of life: the value of add-on arrhythmia surgery in patients with paroxysmal, permanent or persistent atrial fibrillation undergoing valvular and/or coronary bypass surgery. J Cardiovasc Electrophysiol, 2010, 21(5): 511-520.
26.	Jais P, Cauchemez B, Macle L, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: The A4 Study. Circulation, 2008, 118(24): 2498-2505.

1. Ball J, Carrington MJ, McMurray JJ, et al. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol, 2013, 167(5): 1807-1824.
2. 肖锡俊, 袁宏声, 唐红, 等. 二尖瓣置换时采用盐水冲洗的射频改良迷宫手术治疗心房颤动. 中华心律失常学杂志, 2006, 10(5): 342-334.
3. Abo-Salem E, Lockwood D, Boersma L, et al. Surgical treatment of atrial fibrillation. J Cardiovasc Electrophysiol, 2015, 26(9): 1027-1037.
4. Gillinov AM, Gelijns AC, Parides MK, et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med, 2015, 372(15): 1399-1409.
5. Grönefeld GC, Hohnloser SH. Quality of life in atrial fibrillation: an increasingly important issue. Eur Heart J Suppl, 2003, 5(H): H25-H33.
6. Rostagno C, Gelsomino S, Capecchi I, et al. Factors related to sinus rhythm at discharge after radiofrequency ablation of permanent atrial fibrillation in patients undergoing mitral valve surgery. Heart Vessels, 2016, 31(4): 593-598.
7. Wolf PA, Benjamin EJ, Belanger AJ, et al. Secular trends in the prevalence of atrial fibrillation: the Framingham Study. Am Heart J, 1996, 131(4): 790-795.
8. Go AS, Hylek EM, Phillips KA, et al. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the An Ticoagulation and Risk Factors in Atrial Fibrillation(ATRIA) Study. JAMA, 2001, 285(18): 2370-2375.
9. Nishimura RA, Carabello BA, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(23): 2440-2492.
10. Voeller RK, Zierer A, Lall SC, et al. The effects of the Cox maze procedure on atrial function. J Thorac Cardiovasc Surg, 2008, 136(5): 1257-1264.
11. Gandek B, Ware JE Jr. Methods for validating and norming translations of health status questionnaires: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol, 1998, 51(11): 953-959.
12. 魏朝晖, 莫一心. 生命质量测定量表 SF-36 的应用. 中国社会医学杂志, 1997, 14(4): 145-147.
13. 李宁秀, 刘朝杰, 李俊, 等. 四川省城乡居民 SF-36 评价参考值. 华西医大学报, 2001, 31(1): 43-47.
14. Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Torac Cardiovasc Surg, 2012, 143(3): 632-638.
15. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol, 2014, 64(21): e1-e76.
16. Kabukcu M, Arslantas E, Ates I, et al. Clinical, echocardiographic, and hemodynamic characteristics of rheumatic mitral valve stenosis and atrial fibrillation. Angiology, 2005, 56(2): 159-163.
17. Abo-Salem E, Lockwood D, Boersma L, et al. Surgical treatment of atrial fibrillation. J Cardiovasc Electrophysiol, 2015, 26(9): 1027-1037.
18. 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 Heart Vasc, 2014, 174(3): 497-502.
19. Loardi C, Alamanni F, Galli C, et al. Surgical treatment of concomitant atrial fibrillation: focus onto atrial contractility. Biomed Res Int, 2015, 2015: 274817.
20. von Oppell UO, Masani N, O'Callaghan P, et al. Mitral valve surgery plus concomitant atrial fibrillation ablation is superior to mitral valve surgery alone with an intensive rhythm control strategy. Eur J Cardiothorac Surg, 2009, 35(4): 641-650.
21. Zorlu A, Amioglu G, Yilmaz N, et al. The relationship between mean pulmonary artery pressure and quality of life in patients with mitral stenosis. Cardiology, 2011, 119(3): 170-175.
22. Dorian P, Jung W, Newman D, et al. The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J Am Coll Cardiol, 2000, 36(4): 1303-1309.
23. Aliot E, Botto GL, Crijns HJ, et al. Quality of life in patients with atrial fibrillation: how to assess it and how to improve it. Europace, 2014, 16(6): 787-796.
24. Hagens VE, Ranchor AV, Van Sonderen E, et al. Effect of rate or rhythm control on quality of life in persistent atrial fibrillation.Results from the Rate Control Versus Electrical Cardioversion (RACE) Study. J Am Coll Cardiol, 2004, 43(2): 241-247.
25. Van Breugel HN, Nieman FH, Accord RE, et al. A prospective randomized multicenter comparison on health-related quality of life: the value of add-on arrhythmia surgery in patients with paroxysmal, permanent or persistent atrial fibrillation undergoing valvular and/or coronary bypass surgery. J Cardiovasc Electrophysiol, 2010, 21(5): 511-520.
26. Jais P, Cauchemez B, Macle L, et al. Catheter ablation versus antiarrhythmic drugs for atrial fibrillation: The A4 Study. Circulation, 2008, 118(24): 2498-2505.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Bi-polar radiofrequency ablation for rheumatic heart disease with atrial fibrillation

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