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Influence of Preoperative Left Atrial Dimension on the Effectiveness of Surgical Radiofrequency Ablation for Treatment　 of Atrial　Fibrillation

Abstract：　Objective　To analyze the influence of preoperative left atrial dimension （LAD） on the effectiveness of surgical radiofrequency ablation for the treatment of atrial fibrillation （AF） through a 5-year postoperative follow-up of AF patients after surgical radiofrequency ablation. Methods　Clinical data of 433 patients with persistent or permanent AF who received bipolar radiofrequency ablation procedures during concomitant cardiac surgery in Beijing Anzhen Hospital from 2006 to 2009 were retrospectively analyzed. All the patients were divided into 4 groups according to their preoperative LAD：Group A， 75 patients with their LAD＜50 mm， including 22 males and 53 females with their average age of 56.50±10.05 years；Group B， 89 patients with their LAD ranging from 50 to 60 mm， including 32 males and 57 females with their average age of 55.63±10.28 years；Group C， 117 patients with their LAD ranging from 60 to 70 mm， including 41 males and 76 females with their average age of 55.13±10.96 years；and Group D， 152 patients with their LAD＞70 mm， including 68 males and 84 females with their average age of 53.22±11.49 years. Postoperative ECG records right after surgery， before discharge， at 6 months and 1，2，3，4 and 5 years during follow-up were collected. The relationship between preoperative LAD and postoperative sinus rhythm restoration rate was analyzed. Results There was statistical difference in sinus rhythm restoration rate right after surgery（P=0. 011）， before discharge（P=0. 002）， at 6 months（P＜ 0. 001） and 1 year （P＜0. 001）， 2 years（P＜0. 001）， 3 years（P＜0. 001）， 4 years（P＜0. 001） and 5 years（P= 0. 006） during follow-up among the 4 groups. Postoperative sinus rhythm restoration rates right at 6 months and 1，2，3， 4 and 5 years during follow-up was 90.4%， 89.9%， 90.3%， 91.3%， 89.1%， and 90.9% in Group A， 80.2%，79.0%，78.1%， 76.1%，72.5%，70.0% in Group B，74.7%，74.0%，71.2%，72.4%，70.0%， and 64.7% in Group C， and 61.8%，57.6%，56.8%，53.9%，50.7%，and 48.6% in Group D， respectively.　Conclusion　Patients with a larger preoperative LAD have a lower postoperative sinus rhythm restoration rate after surgical radiofrequency ablation for the treatment of AF.

Comparison of Clinical Outcomes of Two Different Radiofrequency Ablation for the Treatment of Permanent Atrial Fibrillation of Patients with Rheumatic Valvular Heart Disease

Objective To compare short-term clinical outcomes of bipolar/unipolar radiofrequency （RF） ablation for the treatment of permanent atrial fibrillation（AF） of patients with rheumatic valvular heart disease. Methods Clinicaldata of 124 patients with rheumatic valvular heart disease and permanent AF who underwent heart valve replacement and　concomitant bipolar/unipolar RF ablation in Wuhan Asia Heart Hospital from February 2011 to December 2011 were retros-　pectively analyzed. According to different RF ablation methods，all the 124 patients were divided into bipolar group and　unipolar group. There were 62 patients in the bipolar group including 29 males and 33 females with their age of 44.20±8.61 years，and 62 patients in the unipolar group including 33 males and 29 females with their age of 46.40±9.48 years. Electrocardiogram examinations were performed at the time of intraoperative heart re-beating，the very postoperative day，7 days，1 month，3 months and 6 months postoperatively to detect restoration of sinus rhythm. Results There was no in-hospital death or ablation-related complication in either group. Aortic cross-clamp time（70.05±22.02 min vs. 54.47±20.65 min，P=0.025） and RF ablation time（25.12±3.00 min vs. 15.70±3.02 min，P=0.000）of the bipolar group were significantly longer than those of the unipolar group. At the time of intraoperative heart re-beating，the lst and 7th day after operation，　sinus rhythm restoration rates were 88.71%，87.10%，80.65% respectively in the bipolar group，85.48%，77.42%，72.58% respectively in the unipolar group，and there was no statistical difference between the two groups （P＞0.05）. In the 1st，3rd and 6th postoperative month，sinus rhythm restoration rates of the bipolar group （79.03%，75.81%，72.58% respectively）　were significantly higher than those of the unipolar group （59.68%，50.00%，48.38% respectively，P＜0.05）. Conclusion　Clinical outcomes of RF ablation for the treatment of permanent AF of patients with rheumatic valvular heart disease are satisfactory. Unipolar RF ablation has the advantage of being time-saving and easier technique，while short-term sinus rhythm restoration rate of bipolar RF ablation is higher than that of unipolar RF ablation for the treatment of permanent AF.

心瓣膜置换术同期双极射频消融治疗心房颤动

目的 总结心内直视下射频消融改良迷宫手术治疗心房颤动（AF）的临床经验，探讨该手术方法的效果。方法 2007年12月至2008年2月在心内直视手术下同期采用射频消融改良迷宫手术治疗AF患者11例,男3例，女8例；年龄22~65岁，平均年龄40.36岁。术前诊断为风湿性心脏病二尖瓣狭窄11例,合并关闭不全5例,左心房血栓3例。采用Atricure双极射频消融系统,按照迷宫手术线路分别经房间沟路径行心内膜射频消融术,同期完成相应的心脏手术。 结果 手术均顺利完成,射频消融手术时间22～50 min，平均30.55min。术后无死亡患者，术后当天有7例(63.64%)转为窦性心律。11例患者均顺利出院。出院后随访1个月以上,10例(9091%)转为窦性心律。结论 心内直视下射频消融改良迷宫手术治疗AF简单、有效，短期临床效果明显。

直视双极射频消融术治疗心瓣膜病合并慢性心房颤动

目的 介绍直视双极射频消融术治疗心瓣膜病合并慢性心房颤动（AF）的初步体会，探讨控制慢性AF的有效方法。 方法 2005年5月至2007年11月，对23例心瓣膜病合并慢性AF患者采用直视双极射频消融术治疗，在常温体外循环心脏跳动下进行右心房的消融，然后在中度低温心脏停搏下做左、右肺静脉口和左心耳的消融隔离，最后行心瓣膜置换术。 结果 射频消融时间18～26 min。术后因特发性血小板减少致消化道大出血住院死亡1例，生存的22例患者随访3～30个月，出院时、3个月、1年和2年窦性心律转复率分别是81.8%、86.4%、82.4%和77.8%，无Ⅲ度房室传导阻滞、病窦综合征和栓塞等并发症发生。 结论 直视双极射频消融术治疗心瓣膜病合并慢性AF操作简单、效果满意、并发症较少。

心内直视下射频消融改良迷宫术治疗心房颤动

目的 总结心内直视下射频消融改良迷宫手术治疗心房颤动的临床经验。 方法 2005年5月～2006年8月在心内直视手术同期采用射频消融改良迷宫手术治疗心房颤动30例，术前诊断风湿性心脏病26例，二尖瓣关闭不全3例，冠心病1例。手术采用Cardioblate TM冲洗式射频消融系统，每例患者分别应用单极系统和双极系统，按照迷宫手术线路分别于左、右心房行心内膜射频消融手术，并切除左、右心耳，同期完成相应的心脏手术。 结果 手术均顺利完成，射频消融手术时间30.5±12.6 min。术后死亡1例，其余29例顺利出院。术后当天21例患者（70.0％）转为窦性心律。29例患者出院后随访7.6±4.8个月，24例（82.8%）为窦性心律,5例（17.2％）为心房颤动或房室结性心律。 结论 心内直视下射频消融改良迷宫手术治疗心房颤动简单、有效，具有良好的临床应用前景。

三维射频消融治疗心房颤动的围手术期护理

【摘要】　目的　总结心房颤动患者行三维射频消的融治疗的护理要点和经验。　方法　对2010年11月-2011年5月收治的62例行三维射频消融治疗心房颤动患者临床资料进行回顾性分析。　结果　62例手术均消融成功，术后发生并发症5例，其中心包压塞1例，迷走神经反射3例，下肢静脉血栓形成1例，经积极治疗和护理均好转出院。　结论　围手术期实施正确有效的护理措施是保证手术和治疗效果的重要因素。

The Value of Sequential TCR Therapy in Obstructive Sleep Apnea Hypopnea Syndrome

目的:探讨TCR(低温等离子射频)序贯治疗在治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)临床疗效。方法:我院2003年8月至2007年2月收治153例轻中度OSAHS患者,采用TCR序贯治疗,初次手术后追踪患者情况,必要时分阶段分部位反复消融,并在术后半年,1年进行PSG检查等,对其疗效、并发症进行分析。结果:153例患者半年有效率86.27%。1年有效率73.20 %,无严重并发症发生。结论:TCR序贯治疗疗效确切,组织反应轻,可作为治疗轻中度OSAHS的有效方案。

Application of Minimally Invasive Techniques in Spleen-Related Diseases

Relationship between Postoperative Atrial Function and Fibrosis of Patients after Mitral Valve Replacement and Concomitant Radiofrequency Ablation for Atrial Fibrillation

ObjectiveTo investigate the restoration of left atrial function and its relationship with atrial fibrosis of patients after mitral valve replacement (MVR)and concomitant radiofrequency ablation (RFA)for atrial fibrillation (AF). MethodsClinical data of 32 patients with mitral valve disease and chronic AF who underwent surgical treatment in General Hospital of Shenyang Military Area Command from January to August 2010 were retrospectively analyzed in this cohort study. There were 11 male and 21 female patients with their age of 49.8±8.7 years. There were 14 patients with rheumatic mitral stenosis (MS), 8 patients with rheumatic MS and mitral regurgitation, and 10 patients with mitral valve prolapse. Preoperative AF duration was 3.6±4.6 years. All the patients received MVR and concomitant RFA for AF. According to the cutting off extent of left atrial fibrosis (10.9%), all the 32 patients were divided into 2 groups. There were 19 patients with more severe left atrial fibrosis ( > 10.9%)in group A and 13 patients with milder left atrial fibrosis ( < 10.9%)in group B. Immunohistochemistry was performed to examined left atrial fibrosis, and echocardiography was performed to examined the structure and function of left atrium. ResultsThere was no perioperative death. Cardiopulmonary bypass time was 84.6±22.6 minutes, aortic cross-clamping time was 47.6±15.6 minutes, and ICU stay was 3.2±1.5 days. All the 32 patients were followed up for longer than 6 months (1.3±0.6 years). The extent of left atrial fibrosis of the 32 patients was 4.8%-18.3% (10.7%±4.2%). There was no statistical difference in left atrial diameter (LAD), left atrial fractional area change (LAFAC)or mitral annular motion between group A and group B preoperatively and 3 months after surgery respectively (P > 0.05). At 6 month after surgery, LAD of group B was significantly smaller than that of group A (P < 0.05), late diastolic mitral annular velocity (Am)of group B was significantly higher than that of group A (P < 0.05), and there was also some improvement in LAFAC of group B compared with group A (P=0.067). Among the 32 patients, 28 patients (87.5%)restored sinus rhythm (SR)3 months after surgery, and 21 patients (65.6%)maintained SR longer than 6 months after surgery. Patients in group B were more likely to maintain SR than patients in group A (P=0.010). ConclusionImprovement of left atrial function can be observed 6 month after MVR and concomitant RFA for AF, which is related to the extent of left atrial fibrosis.

Biatrial Ablation versus Right Atrial Ablation in the Surgical Treatment of Atrial Fibrillation for Adult Patients with Atrial Septal Defect

ObjectiveTo compare clinical outcomes between biatrial ablation and right atrial ablation in the surgical treatment of atrial fibrillation (AF)for adult patients with atrial septal defect (ASD). MethodsClinical data of 47 patients with ASD and AF who underwent surgical ASD repair and radiofrequency ablation from January 2007 to December 2012 were retrospectively analyzed. There were 20 male and 27 female patients with their age of 35-76 years. AF duration ranged from 3 months to 15 years. There were 18 patients with persistent AF and 29 patients with long-standing persistent AF. There were 10 patients with mild-to-moderate or more severe mitral regurgitation (MR), and 28 patients with mild-to-moderate or more severe tricuspid regurgitation (TR). According to different surgical strategies, all the 47 patients were divided into 2 groups. In right atrial ablation group, there were 19 patients who received ASD repair and right atrial ablation. In biatrial ablation group, there were 28 patients who received ASD repair and biatrial ablation. For patients with mild-to-moderate or more severe MR or TR, concomitant mitral or tricuspid valvuloplasty was performed. All the patients received 24-hour Holter monitoring at 3, 6 and 12 months after discharge, and were intermittently followed up thereafter. ResultsCardio-pulmonary bypass time, aortic cross-clamping time and postoperative hospital stay of biatrial ablation group were significantly longer than those of right atrial ablation group. But there was no statistical difference in postoperative morbidity or recovery between the 2 groups. After heart rebeating, there were 25 patients (89.3%)with sinus rhythm (SR)and 3 patients with junc-tional rhythm (JR), and none of the patients had AF in biatrial ablation group. There were 14 patients (73.7%)with SR, 2 patients with JR and 3 patients with AF in right atrial ablation group. At discharge, 28 patients (100%)in biatrial ablation group had SR, and in right atrial ablation group there were 15 patients (78.9%)with SR and 4 patients with AF relapse (P=0.045). All the patients were followed up for 3-75 months, and there was no death or residual ASD shunt during follow-up. Two patients had mild-to-moderate or more severe MR, and 4 patients had mild-to-moderate or more severe TR. Cumulative SR maintenance rate of biatrial ablation group (87.7%±6.7%)was significantly higher than that of right atrial ablation group (47.4%±11.5%, P=0.003)at 2 years after discharge. ConclusionFor adult patients with ASD and AF, biatrial ablation can produce better clinical outcomes than right atrial ablation without increasing surgical risks.