A Study of Treatments for Atrial Fibrillation by Radiofrequency Modified mazeⅢ and Ganglionic Plexus Ablation
|Keywords||Atrial fibrillation Radiofrequency modified maze Ⅲ Ganglionic plexus Ablation|
ObjectiveAtrial fibrillation(AF) is the most common arrhythmia,and it is increaseing with age. AF is associated with a1.5-to2.0-fold increase in mortality and a significant two-to five-fold increase in stroke for patients with cardiovascular diseases. It is a serious threat to people’s health. This project aims to analyze the process, effectiveness and influence factors of radiofrequency modified maze III(RFMM III) and ganglionic plexus(GP) ablation in the patients with AF undergone open-heart surgery.MethodsThe surgical group include102patients who undergone PFMM Ⅲ and GP ablation surgical treatment of valvular heart disease, congenital heart disease and coronary atherosclerosis sclerotic heart disease with AF from December2009to December2011. Male36cases, female68cases, aged28to72years old, average as51.9years old. The duration time of AF was0.5to420months, average as76.7months Preoperative heart function classification by New York Heart Association(NYHA): level Ⅱ is19cases; level III is72cases; level IV is11cases. Preoperative cardiac ultrasound shows the diameter of left atrium is4.05cm-7.6cm,.All patients were adopted with deformity correction of congenital heart,disease valve replacement or/and forming and/or coronary artery bypass surgery. At the same time, all patients were adopted with RFmaze III+GP ablation. The whole group was operated under general anesthesia and it is adopted with sternum midline incision approach, After6month’s follow-up on a regular basis. Get the follow-up to evaluate the validity. None Of atrial tachyarrhythmia episodes are considered to be a successful operation. Using the SPSS17.0statistical software packages to deal with the data colleted. X2test method is chosen to analyse the impact, if p<0.05, it exists significant difference.ResultsThe time of GP ablation in surgical group was about15-20min, the time of RFmaze III was about15-20min, aortic clamping time was about16-186min (mean±standard deviation,63.5±28.4min), The bypass time was about35-248min (mean±standard deviation,99.9±34.7min). Postoperative mortality was attributed to low cardiac output in1, re-thoratomy for homeostasis in3and incision infection in2. AF disappeared in all cases postoperatively by electrocardiogram (sinus rhythm93.1%; junctional rhythm6.9%). At6-month follow-up, the maitenance rate of sinus rhythm is84.2%, junctional rhythm in6patients (6.3%), AF recurred in9patients (9.5%). Left atrial diameter and history of AF are the risk factors of recurrence after RFMM III and GP ablation(P=0.027and0.040, respectively).In the meantime, after radiofrequency ablation in congenital heart disease and acquired heart disease, the rate of recurrence of AF had no statistical difference (p=0.686).Conclusions(1) The RFMM Ⅲ and GP ablation is a relatively simple procedure with satisfactory results and easy operation, which can yield higher freedom from AF.(2) This operation has some innovative and good prospects for the development of the surgical treatment of AF, and it deserve applying extends. But the development and improvement is expected to receive more clinical application and long-term follow-up, so as to enhance the long-term efficacy of the operation.(3) Preoperative patients with poor cardiac function shoud be improved their cardiac function. Choose the right operation time when the cardiac function is better, Treatment effect is more satisfactory.(4) Eliminating AF need atrial full-thickness "wall" and radiofrequency ablation lines to connect fully When ablation for,that is the key to success.