The Long-term Efficacy of Radiofrequency Modified Maze Procedure Combined with Open-heart Surgery for Atrial Fibrillation
|Keywords||Modified maze procedure Intracardiac RFA Atrial Fibrillation Mitral Valve Replacement CPB time Nodal rhythm Aortic Tricuspid ring Modified maze procedure Sinus Echocardiography AF Cardiac resuscitation Cardiac Surgery Long-term efficacy fibrillation Cardioversion rate The left atrium and left ventricle|
Background: Intraoperative ablation of concurrent atrial fibrillation (AF) duringopen-heart surgery is today advised in most cases. While pulmonary vein isolation (PVI)alone has proven quite effective in treating concomitant paroxysmal AF, it is generallyagreed that patients affected by persistent and especially permanent AF require acomplete left lesion set involving connections between the PV encirclings and fromthose to the mitral annulus. Bipolar radiofrequency clamps are to date the most reliablytransmural ablation devices available to the surgeon. Nevertheless, due to its clampingnature and its deep tissue penetration, bipolar radiofrequency has not been used toperform the mitral connecting line. So, the rising popularity of bipolar radiofrequencyhas led many surgeons to either treat patients with incomplete lesion sets, which isclinically not convenient, or to use an additional unipolar device to complete the mitralline, which is probably not as efficient, and surely not cost-effective. We describe hereour long-term results with bipolar radiofrequency to perform modified Maze procedurecombined with open-heart surgery for atrial fibrillation.Objective: In studying the long-term results in open heart surgery patientsundergoing atrial fibrillation ablation with bipolar radiofrequency to perform modifiedMaze procedure. We also evaluate the clinical value of bipolar radiofrequency toperform modified Maze procedure under open heart surgery.Methods: From January2007to June2012,76patients (21males and55females,aged20-68years old, mean47.91±10.45years old) suffered from both rheumaticvalves disease and atrial fibrillation underwent atrial fibrillation ablation (bipolarradiofrequency alone) to perform modified Maze procedure at the same time of valvestransplantation. There were16single mitral valves disease,36mitral valves disease combined with tricuspid valves disease,9mitral valves disease combined with aorticvalves disease,15mitral valves disease combined with aortic valves disease andtricuspid valves disease,44thrombosis in left atrium. Rhythm documented onpostoperative electrocardiograms was used to evaluate the long-term results of atrialfibrillation ablation with with bipolar radiofrequency to perform modified Mazeprocedure. We compared the pre-operation LAD, LVDS and EF of the echocardiogramto post-operation LAD, LVDS and EF of the echocardiogram. Follow-up Follow-upelectrocardiography and color Doppler echocardiography were performedpostoperatively3-36months by telephone or out-patient deparment.Results: The mean aortic cross-clamping time was67.1±24.3minutes, andcardiopulmonary bypass time was108.3±14.2minutes. The mean bipolar ablation timewas15-38minutes. Atrial fibrillations of all patients were disappeared at the end ofcardiopulmonary bypass. There were58(76.32%) sinus rhythm patients,11(14.47%)nodal rhythm patients,7(9.21%)trial flutter patients. There was no abnormal bleedingdue to bipolar radiofrequency ablation. Two patients died of low cardiac outputsyndrome and multi-organ failure in hospital in1month. Follow-up time was3-36months:2dead (1from cerebral hemorrhage in the third year and1from cerebralembolism in the second year); there were62sinus rhythm in the72(86.1%) alivepatient. The post-operation LAD and LVED decreased comparing with pre-operationLAD and LVED by echocardiogram.Conclusions: atrial fibrillation ablation with bipolar radiofrequency to performmodified Maze procedure is an effective and safe technique for treating atrial fibrillationin patients with rheumatic heart disease undergoing valve replacement, with promisingmid-term and long-term follow-up results.