Objective To evaluate clinical results of concomitant mitral valve replacement （MVR） and modified maze procedure with Atricure bipolar radiofrequency for chronic atrial fibrillation （AF）. Methods Clinical data of 59 patients with mitral valve diseases and chronic AF who underwent concomitant MVR and bipolar radiofrequency ablation in Subei People’s Hospital from June 2010 to September 2012 were retrospectively analyzed. There were 22 male and 37 female patients with their age of 29-71 （48±11） years. The AF duration was 1.2-26.0 （7.2±3.4） years. Preoperatively，there were 20 patients with New York Heart Association （NYHA） class Ⅱ，31 patients with NYHA class Ⅲ and 8 patients with NYHA class Ⅳ. There were 32 patients with moderate to severe mitral stenosis，9 patients with moderate to severe mitral regurgitation and 18 patients with combined mitral stenosis and regurgitation. There were 42 patients with tricuspid regurgitation. The left artial dimension was 39-98 （55.2±8.9） mm. Left atrial thrombus was found in 9 patients. Atricure bipolar radiofrequency system was used for right atrial ablation under normothermic cardiopulmonary bypass （CPB） with beating heart first，then for ablations of the left and right pulmonary vein orifices and left atrium under moderate hypothermia with heart arrest. MVR was performed after ablation procedures were completed. Amiodarone was routinely used postoperatively and patients were periodically followed up after discharge. Results There was no in-hospital death. CPB time was 65-180 （99±28）minutes，aortic cross-clamping time was 46-123 （69±17）minutes，and ablation time was 15-28 （21±4）minutes. Postoperatively，heart rhythm immediately changed to sinus rhythm （SR） in 44 patients，remained AF in 10 patients and atrial flutter in 1 patient. Temporary pacemaker was used for 4 patients with bradycardia （3 patients recovered SR and 1 patient remained AF later）. Fifty-eight patients were followed up after discharge for 6-33 months，and 1 patient was lost during follow-up. Patients’ SR rate was 86.2 % （50/58），91.4% （53/58），89.7 % （52/58），84.6 % （33/39）and 71.4 % （5/7）at discharge，3 months，6 months，1 year and 2 years after discharge respectively. There was no thrombotic event during follow-up. Conclusion Concomitant MVR and modified maze procedure with Atricure bipolar radiofrequency is a safe procedure for chronic AF with good short-term results.
Abstract： Objective To summarize the clinical outcomes of maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for the surgical treatment of permanent atrial fibrillation（AF） and rheumatic valve diseases. Methods A total of 124 patients with permanent AF and rheumatic valves diseases undergoing surgical treatment from March 2006 to October 2010 in the First Affiliated Hospital of Sun Yat-sen University were randomly divided into ablation group and control group using coin method with 62 patients in each group. The mean atrial fibrillation duration was（56.1±47.1） months in ablation group, and patients in this group underwent maze procedure using bipolar radiofrequency ablation and valve replacement. The mean atrial fibrillation duration was（43.8±25.6） months in control group, and patients in this group underwent only valve replacement. Demographic characteristics, cardiopulmonary bypass（CPB）time, aortic cross-clamping（ACC）time, mechanical ventilation time, intensive care unit（ICU） length of stay, postoperative complications and follow-up outcomes were compared between the two groups. Results The demographic characteristics of the two groups were not statistically different （P＞0.05）. The CPB time and ACC time between the two groups were not statistically different （P＞ 0.05）. The postoperative hospital stay of ablation group was significantly longer than that of control group （15.8±6.1 d vs. 12.9±3.1d，P=0.001）. No patient needed permanent pacemaker implantation in either group. Postoperative ejection fraction of ablation group was significantly higher than that of control group（59.6%±9.2% vs. 55.5%±5.4%，P＜ 0.01）. The rate of sinus rhythm maintenance at 6 months, 12 months, 18 months, 24 months during follow-up in ablation group were 88.5%, 87.5%, 87.1% and 82.4% respectively, 3.3%, 2.2%, 0.0%, and 0.0% in control group respectively, which was statistically different between the two groups（P＜ 0.05）. Conclusion Maze procedure using bipolar radiofrequency ablation is an effective surgical procedure for the treatment of permanent atrial fibrillation.
ObjectiveTo investigate the effectiveness of arthroscopic bipolar radiofrequency energy (bRFE) and lateral partial meniscectomy for lateral meniscus tear and cartilage lesion. MethodsBetween January 2011 and December 2012, 40 eligible patients with lateral meniscus tear and cartilage injury in the lateral knee compartment underwent arthroscopic treatment, and the clinical data were analysed retrospectively. There were 21 males and 19 females, aged 15-65 years (mean, 42.1 years). The left knee was involved in 22 cases and the right knee in 18 cases. The causes of injury included sport injuries in 5 cases and sprain of knee joints in 8 cases, the remaining patients had no history of trauma. The disease duration ranged from 1 month to 10 years (median, 10 months). The Lysholm score and Japanese Orthopaedic Association (JOA) score of the knee were 59.9±8.2 and 69.6±5.3. According to the Outerbridge classification, 2 cases were rated as grade I, 21 cases as grade II, 17 cases as grade III, and 10 cases as grade IV. The scores described by Noyes were 1-16 (mean, 6.52). The Noyes scores were from 1 to 6 points in 20 patients (group A) and 7 to 16 points in 20 patients (group B). During surgery, all patients underwent partial meniscectomy, and radiofrequency-based chondroplasty was used. Knee joint function was assessed using the Lysholm score and JOA score of the knee, and the clinical outcomes between different degrees of cartilage lesions were also compared. ResultsAll incisions healed primarily without complication. All the patients were followed up 8-31 months (mean, 18.1 months). The Lysholm and JOA scores of the knee at last follow-up (92.2±7.2 and 92.9±7.9, respectively) were significantly higher than those at preoperation (P<0.05). There was no significant difference in preoperative Lysholm and JOA scores of the knee between groups A and B (P>0.05), but significance difference was found between 2 groups at last follow-up (P<0.05). ConclusionArthroscopic bRFE and lateral partial meniscectomy have good effectiveness in treating lateral meniscus tear and cartilage lesion. The effectiveness is better in patients with mild cartilage lesion than in patients with severe cartilage lesion.
ObjectiveTo evaluate the mid-term recovery of cardiac function after heart valve replacement and concomitant bipolar radiofrequency ablation for atrial fibrillation (AF). Methods Clinical data of 191 patients with heart valve disease and AF in the same surgical team of Xinqiao Hospital from January 2011 Jan to December 2013 was retrospectively analyzed. Heart valve replacement was performed for a control group (n=93), which includes 31 males and 62 females with their age of 48.33±7.55 years and AF duration of 4.80±2.03 years. Valve replacement and concomitant bipolar radiofrequency ablation was performed for a synchronism ablation group (n=98), which includes 27 males and 71 females with their age of 46.95±7.70 years and AF duration of 5.06±2.26 years. The echocardiogram, electrocardiogram and complications at hospitalization, 6 months, 1 year and 2 year after operation were analyzed. ResultsNo in-hospital death occurred. There were statistical differences in aortic cross-clamp time, cardiopulmonary bypass time, tricuspid ring, ICU stay, total volume of postoperative drainage between the two groups. All the patients were followed up for 2 years. Two years postoperatively, in the synchronism ablation group, 85 patients (86.73%) were followed up, 1 patient with cerebral embolism, 2 patients with cerebral hemorrhage. In the control group, 85 patients (91.40%) were followed up, 4 patients with cerebral embolism, 2 patients with cerebral hemorrhage. There were no death, cardiac rupture, and permanent cardiac pacemaker implantation in the two groups during the follow-up. One year and 2 years postoperative fractional shortening of the synchronism ablation group was significantly higher than those of the control group (37.18%±5.35% vs. 34.72%±6.40%, P=0.007; 37.95%±7.99% vs. 35.18%±5.15%, P=0.008). One year and 2 years postoperative left ventricular ejection fraction of the synchronism ablation group was significantly higher than that of the control group (66.27%±6.99% vs. 63.33%±8.14%, P=0.012). The rate of self-feeling cardiac function improvement in 1 year and 2 years after surgery of the synchronism ablation group was significantly higher than that of the control group (85.39% vs. 72.94%, P=0.005; 84.71% vs. 68.24%, P=0.005). ConclusionCardiac function of the mid-term after the valve replacement and concomitant bipolar radiofrequency ablation for atrial fibrillation obviously improves.
ObjectiveTo evaluate the efficacy of bipolar radiofrequency ablation procedure for atrial fibrillation (AF) during the open-heart surgery. MethodsWe retrospectively analyzed the clinical data of 137 heart disease patients combined with AF (21 patients combined with left atrial thrombus) who underwent one-stage operation of open-heart surgery and bipolar radiofrequency ablation from May 2009 to June 2014. There were 61 males and 76 females at age of 35-73(48.3±11.6)years. The patients received amiodarone treatment for 6 months after surgery and regular follow-up. The sinus rhythm conversion rate, cardiac function before and after operation, survival rate after operation, the incidence of thromboembolism and other complications were recorded. ResultsThe average cardiopulmonary bypass time during operation was 122±38 min, the average aortic crossclamp time was 78±22 min, and the average radiofrequency ablation time was 20±4 min. The atrial fibrillation was successfully ablated in 130 patients on the same day of surgery with conversion rate of 94.9%. The atrial fibrillation was converted to sinus rhythm in 114 patients, and converted to junctional cardiac arrhythmia in 16 patients. Two patients died during the perioperative period with death rate of 1.5% in hospital. The conversion rate was 81.5% (110/135), 88.1% (111/126), 83.1% (74/89), and 83.0% (39/47) respectively at one month, six months, one year, and two years after surgery, respectively. The survival rate was 96.6% (86/89) and 93.6% (44/47) at one year and two years after surgery. No thromboembolism occurred during the long-term follow-up period. ConclusionBipolar radiofrequency ablation procedure selectively performed during open-heart surgery can cure atrial fibrillation, only increases cardiopulmonary bypass and aortic crossclamp time slightly. The short- and mid-term efficacy is satisfactory with high conversion rate of sinus rhythm. The long-term effect still needs further observation.
Objective To evaluate the efficacy and clinical significance of bipolar radiofrequency ablation in the treatment of left ventricular aneurysm with ventricular arrhythmias guided by CARTO mapping system. Methods From September 2009 to December 2015, 56 patients with ventricular aneurysm following myocardial infarction were enrolled. All patients suffered different levels of angina pectoris symptoms evaluated by Holter (the frequencies of ventricular arrhythmias more than 3 000 per day). They were divided into two groups according to random ballot and preoperative communication with patients' family members: a bipolar radiofrequency ablation group (n=28, 20 males, 8 females, mean age of 61.21±1.28 years) receiving off-pump coronary artery bypass grafting (OPCABG), ventricular aneurysm surgery combined with bipolar radiofrequency ablation, and a non-bipolar radiofrequency ablation group (n=28, 22 males, 6 females, mean age of 57.46±1.30 years) receiving OPCABG and single ventricular aneurysm surgery. The grade of cardiac function and ventricular arrhythmia was compared between the two groups during pre-operation, discharge and follow-up. Results All patients were discharged successfully. There was no in-hospital death in both two groups. One patient in the non-radiofrequency group had cerebral infarction. All patients were re-checked with Holter before discharge and the frequency of ventricular arrhythmias significantly decreased compared to that of pre-operation in both groups, and was more significant in bipolar radiofrequency ablation group (1 197.00±248.20 times/24 h vs. 1 961.00±232.90 times/24 h, P<0.05). There was significant difference in duration of mechanical ventilation and ICU stay between the two groups (P<0.05). The left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) significantly improved (P<0.05) after operation in both groups. Conclusion The clinical efficacy of bipolar radiofrequency ablation in the treatment of ventricular aneurysm with ventricular arrhythmia guided by CARTO mapping is safe and effective, but its long-term outcomes still need further follow-up.