Clinical research on radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Song ,  WANG Jixiang

Department of Cardiothoracic Surgery, Sichuan Mianyang 404 Hospital, Mianyang, 621000, Sichuan, P.R.China;

Corresponding author：

WANG Jixiang, Email: wjx391@sohu.com

Keywords：

Totally thoracoscopic surgery; median sternotomy; mitral valve replacement; atrial fibrillation; radiofrequency ablation; treatment

DOI：

10.7507/1007-4848.201911050

Video：

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Objective To investigate the feasibility, safety and effectiveness of radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery.Methods The clinical data of 107 patients with rheumatic mitral disease and atrial fibrillation who underwent mitral valve replacement and radiofrequency ablation at the same time in our hospital from January 2014 to October 2018 were retrospectively analyzed. The patients were divided into two groups: a totally thoracoscopic surgery group (n=51, including 20 males and 31 females, aged 50.57±5.24 years) and a median sternotomy group (n=56, including 21 males and 35 females, aged 52.12±5.59 years) according to the surgical methods. The preoperative, intraoperative and postoperative data of the patients were compared.Results All operations were successfully completed without death. In terms of bleeding volume, drainage volume, ventilator-assisted breathing time, hospital stay and incision length, the totally thoracoscopic surgery group was better than the median sternotomy group, and the difference was statistically significant (P<0.05). The cardiopulmonary bypass time and radiofrequency ablation time in the totally thoracoscopic surgery group were longer than those in the median sternotomy group (P<0.05). There was no significant difference in the operation time, aortic occlusion time, postoperative complications, left ventricular ejection fraction, left atrial diameter and sinus rhythm maintenance between the two groups (P>0.05). There was no atrioventricular block, pulmonary vein stenosis, atrioesophageal fistula, coronary artery injury, stroke or hemorrhage during the follow-up.Conclusion Radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery is safe and effective, and it is worthy of clinical application.

Citation： WU Song, WANG Jixiang. Clinical research on radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(8): 874-879. doi: 10.7507/1007-4848.201911050 Copy

1.	刘浩, 周婷. 心房颤动的病理生理和危害. 临床内科杂志, 2013, 30(1): 5-7.
2.	Zhu X, Li Q, Li Y, et al. Analysis of bipolar radiofrequency ablation in treatment of atrial fibrillation associated with rheumatic heart disease. PLoS One, 2016, 11(3): e0151248.
3.	孟旭. 房颤的外科消融治疗进展. 医学与哲学, 2016, 37(24): 10-12.
4.	Cox JL. A brief overview of surgery for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1): 80-88.
5.	Jacobaeus HC. The cauterization of adhesions in artificial pneumothorax treatment of pulmonary tuberculosis under thoracoscopic control. Proc R Soc Med, 1923, 16(Electro Ther Sect): 45-62.
6.	Maruszewski M, Smoczyński R, Kowalewski M, et al. Pilot study of totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery. Towards even less invasive? Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 326-332.
7.	Lan H, Cheng YG, Jia BC, et al. Clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement: a series of 634 cases. Zhonghua Wai Ke Za Zhi, 2016, 54(8): 609-612.
8.	Jiang Q, Yu T, Huang K, et al. Feasibility, safety, and short-term outcome of totally thoracoscopic mitral valve procedure. J Cardiothorac Surg, 2018, 13(1): 133.
9.	柳德斌, 王炜, 王玮璠, 等. 全胸腔镜下二尖瓣置换/成形 127 例疗效分析. 中国循环杂志, 2017, 32(z1): 132-133.
10.	Firmansyah DK, Soesanto AM, Hanafy DA, et al. Cox maze Ⅳversus left atrial reduction for atrial contraction restoration. Asian Cardiovasc Thorac Ann, 2019, 27(5): 353-361.
11.	吴松, 王继相. 心房颤动的外科治疗研究进展. 中国心血管病研究, 2018, 16(10): 892-894.
12.	Vannucchi V, Moroni F, Grifoni E, et al. Management of oral anticoagulation in very old patients with non valvular atrial fibrillation related acute ischemic stroke. J Thromb Thrombolysis, 2020, 49(1): 86-93.
13.	Rose DZ, Meriwether JN, Fradley MG, et al. Protocol for AREST: Apixaban for early prevention of recurrent embolic stroke and hemorrhagic transformation-a randomized controlled trial of early anticoagulation after acute ischemic stroke in atrial fibrillation. Front Neurol, 2019, 10: 975.
14.	Jewett GA, Lindsay MP, Goia C, et al. National trends in hospital admission, case fatality, and sex differences in atrial fibrillation-related strokes. Int J Stroke, 2019. [Epub ahead of print].
15.	郭秋哲, 郭应强. 心房颤动外科治疗的历史与现状. 心血管病学进展, 2013, 34(3): 356-359.
16.	Cox JL. Surgical management of cardiac arrhythmias. Cardiovasc Clin, 1987, 17(3): 381-413.
17.	Zhang Y, Zhu L. Surgical ablation of atrial fibrillation. Int J Cardiol Heart Vessel, 2014, 4: 7-11.
18.	Lapenna E, De Bonis M, Giambuzzi I, et al. Long-term outcomes of stand-alone mazeⅣfor persistent or long-standing persistent atrial fibrillation. Ann Thorac Surg, 2020, 109(1): 124-131.
19.	Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-mazeⅣprocedure in its second decade: Still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
20.	谭程, 孙小康, 黄磊. 二尖瓣机械瓣膜置换同期行双极射频消融术治疗心房颤动的早期疗效. 四川医学, 2016, 37(7): 788-790.
21.	Liu J, Chen B, Zhang YY, et al. Mitral valve replacement via minimally invasive totally thoracoscopic surgery versus traditional median sternotomy: a propensity score matched comparative study. Ann Transl Med, 2019, 7(14): 341.
22.	陈波. 微创全胸腔镜与传统正中开胸二尖瓣置换手术的倾向性评分匹配研究. 汕头大学, 2017.
23.	万丽丽. 全胸腔镜下二尖瓣置换手术的安全性研究. 中华实验外科杂志, 2019, 36(8): 1479-1481.
24.	Fan H, Xi Ming Q, Wei Min Z, et al. Comparison of totally thoracoscopic and traditional sternotomy approaches for mitral valve replacement. Heart Surg Forum, 2019, 22(4): E310-E314.
25.	Zhao G, Gao J, Liu Y, et al. Two-incision totally thoracoscopic approach for mitral valve replacement. Int Heart J, 2017, 58(6): 894-899.
26.	Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339(10): 659-666.
27.	叶红雨, 黄伟钊, 吴颖猛, 等. 术中单极和双极射频消融治疗心房纤颤的疗效与安全性比较. 实用医学杂志, 2013, 29(1): 75-77.
28.	陈磊, 沈振亚, 余云生, 等. 房颤患者射频消融术治疗疗效分析. 浙江临床医学, 2016, 18(11): 2001-2003.
29.	陈哲. 瓣膜手术中行双极射频消融术与单极射频消融术治疗房颤的比较. 浙江大学, 2013.
30.	刘涧, 孙玉喜, 黎辉. 心房颤动射频消融术后复发的相关因素研究. 国际心血管病杂志, 2017, 44(6): 341-343.
31.	顾闻达, 郭惠明, 卢聪, 等. 心脏手术同期射频消融治疗房颤的中长期疗效分析. 中华胸心血管外科杂志, 2016, 32(3): 147-150.
32.	王晓雅, 徐燕爽, 叶卉. 持续性房颤患者射频消融术中体表心电图 V1 导联 f 波振幅与术后复发的关系. 山东医药, 2016, 56(10): 60-61.
33.	欧石, 戴明, 陈中坚, 等. 单双极射频消融术治疗心房颤动的疗效及安全性比较. 中国实用医刊, 2015, 42(2): 98-99.

1. 刘浩, 周婷. 心房颤动的病理生理和危害. 临床内科杂志, 2013, 30(1): 5-7.
2. Zhu X, Li Q, Li Y, et al. Analysis of bipolar radiofrequency ablation in treatment of atrial fibrillation associated with rheumatic heart disease. PLoS One, 2016, 11(3): e0151248.
3. 孟旭. 房颤的外科消融治疗进展. 医学与哲学, 2016, 37(24): 10-12.
4. Cox JL. A brief overview of surgery for atrial fibrillation. Ann Cardiothorac Surg, 2014, 3(1): 80-88.
5. Jacobaeus HC. The cauterization of adhesions in artificial pneumothorax treatment of pulmonary tuberculosis under thoracoscopic control. Proc R Soc Med, 1923, 16(Electro Ther Sect): 45-62.
6. Maruszewski M, Smoczyński R, Kowalewski M, et al. Pilot study of totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery. Towards even less invasive? Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 326-332.
7. Lan H, Cheng YG, Jia BC, et al. Clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement: a series of 634 cases. Zhonghua Wai Ke Za Zhi, 2016, 54(8): 609-612.
8. Jiang Q, Yu T, Huang K, et al. Feasibility, safety, and short-term outcome of totally thoracoscopic mitral valve procedure. J Cardiothorac Surg, 2018, 13(1): 133.
9. 柳德斌, 王炜, 王玮璠, 等. 全胸腔镜下二尖瓣置换/成形 127 例疗效分析. 中国循环杂志, 2017, 32(z1): 132-133.
10. Firmansyah DK, Soesanto AM, Hanafy DA, et al. Cox maze Ⅳversus left atrial reduction for atrial contraction restoration. Asian Cardiovasc Thorac Ann, 2019, 27(5): 353-361.
11. 吴松, 王继相. 心房颤动的外科治疗研究进展. 中国心血管病研究, 2018, 16(10): 892-894.
12. Vannucchi V, Moroni F, Grifoni E, et al. Management of oral anticoagulation in very old patients with non valvular atrial fibrillation related acute ischemic stroke. J Thromb Thrombolysis, 2020, 49(1): 86-93.
13. Rose DZ, Meriwether JN, Fradley MG, et al. Protocol for AREST: Apixaban for early prevention of recurrent embolic stroke and hemorrhagic transformation-a randomized controlled trial of early anticoagulation after acute ischemic stroke in atrial fibrillation. Front Neurol, 2019, 10: 975.
14. Jewett GA, Lindsay MP, Goia C, et al. National trends in hospital admission, case fatality, and sex differences in atrial fibrillation-related strokes. Int J Stroke, 2019. [Epub ahead of print].
15. 郭秋哲, 郭应强. 心房颤动外科治疗的历史与现状. 心血管病学进展, 2013, 34(3): 356-359.
16. Cox JL. Surgical management of cardiac arrhythmias. Cardiovasc Clin, 1987, 17(3): 381-413.
17. Zhang Y, Zhu L. Surgical ablation of atrial fibrillation. Int J Cardiol Heart Vessel, 2014, 4: 7-11.
18. Lapenna E, De Bonis M, Giambuzzi I, et al. Long-term outcomes of stand-alone mazeⅣfor persistent or long-standing persistent atrial fibrillation. Ann Thorac Surg, 2020, 109(1): 124-131.
19. Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-mazeⅣprocedure in its second decade: Still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): i19-i25.
20. 谭程, 孙小康, 黄磊. 二尖瓣机械瓣膜置换同期行双极射频消融术治疗心房颤动的早期疗效. 四川医学, 2016, 37(7): 788-790.
21. Liu J, Chen B, Zhang YY, et al. Mitral valve replacement via minimally invasive totally thoracoscopic surgery versus traditional median sternotomy: a propensity score matched comparative study. Ann Transl Med, 2019, 7(14): 341.
22. 陈波. 微创全胸腔镜与传统正中开胸二尖瓣置换手术的倾向性评分匹配研究. 汕头大学, 2017.
23. 万丽丽. 全胸腔镜下二尖瓣置换手术的安全性研究. 中华实验外科杂志, 2019, 36(8): 1479-1481.
24. Fan H, Xi Ming Q, Wei Min Z, et al. Comparison of totally thoracoscopic and traditional sternotomy approaches for mitral valve replacement. Heart Surg Forum, 2019, 22(4): E310-E314.
25. Zhao G, Gao J, Liu Y, et al. Two-incision totally thoracoscopic approach for mitral valve replacement. Int Heart J, 2017, 58(6): 894-899.
26. Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339(10): 659-666.
27. 叶红雨, 黄伟钊, 吴颖猛, 等. 术中单极和双极射频消融治疗心房纤颤的疗效与安全性比较. 实用医学杂志, 2013, 29(1): 75-77.
28. 陈磊, 沈振亚, 余云生, 等. 房颤患者射频消融术治疗疗效分析. 浙江临床医学, 2016, 18(11): 2001-2003.
29. 陈哲. 瓣膜手术中行双极射频消融术与单极射频消融术治疗房颤的比较. 浙江大学, 2013.
30. 刘涧, 孙玉喜, 黎辉. 心房颤动射频消融术后复发的相关因素研究. 国际心血管病杂志, 2017, 44(6): 341-343.
31. 顾闻达, 郭惠明, 卢聪, 等. 心脏手术同期射频消融治疗房颤的中长期疗效分析. 中华胸心血管外科杂志, 2016, 32(3): 147-150.
32. 王晓雅, 徐燕爽, 叶卉. 持续性房颤患者射频消融术中体表心电图 V1 导联 f 波振幅与术后复发的关系. 山东医药, 2016, 56(10): 60-61.
33. 欧石, 戴明, 陈中坚, 等. 单双极射频消融术治疗心房颤动的疗效及安全性比较. 中国实用医刊, 2015, 42(2): 98-99.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical research on radiofrequency ablation of atrial fibrillation with mitral valve replacement under totally thoracoscopic surgery

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