Comparison of Bipolar and Unipolar Radiofrequency Ablation Combined with Vavle Surgery for Atrial Fibrillation
|Keywords||atrial fibrillation Maze procedure radioffequency(RF) mitralvavle|
Objective:The purpose of this study is to compare the efficacy of bipolar with unipolar Saline-irrigated Radiofrequency Modified Maze Procedure combined with mitral vavle surgery for atrial fibrillationMethod:Between July2010and March2013,23patients underwent the bipolar saline-irrigated radiofrequency modified Maze III procedure for atrial fibrillation combined with mitral vavle surgery in Zhejiang first Hospital(group A). They were compared to33patients underwent the bipolar saline-irrigated radiofrequency modified Maze III procedure for atrial fibrillation combined with mitral vavle surgery(group B) and22patients with atrial fibrillation who underwent mitral vavle surgery without the modified Maze procedure during the same interval(group C). The patients in the3groups were similar in age, gender,preoperative NYHA class, duration of atrial fibrillation, preoperative left atrial dimension, basic diseases and kinds of combined operation. We retrospectively reviewed the detailed clinical profile and follow—up data were available through mail questionaire and telephone interview. The data about rhythms, heart function and strokes were collected after clinical evaluation, electrocardiogram and echocardiogram had been done. The atrial pump function of some patients who returned to sinus rhythm postoperatively was evaluated through echocardiography. The data were analyzed with SPSS and the statistical significancewas defined as P<0.05.Result:The duration of cardiopulmonary bypass of group A is74.70×19.22min, the group B was68,88×16.95min, no significant difference was found in two groups (p=0.249), the group A, on average, the duration of cardiopulmonary bypass is5.92min more than the group B. aotic crossclamping of group A is47.48×16.59min, the group B was38.27×11.90min, significant difference was found in two groups (p=0.028), the group A, on average, the aotic crossclamping time than the group B was9.21×3.56min longer, group A had no perioperative death, group B had2patients (6.06%) perioperative mortality of two groups had no significant difference (p=0.243). Compared with group C, the two groups had no significant difference (p=1.000, p=0.254) in complications, Complication rate of group A and the group B had no significant difference (VS121.21%21.74%, p=0.962), There is also no significant difference (p were0.077,0.077) compared with the group C. group A hospitalization7.57±1.20days (6-11days), control group was7.55±1.09(6-11days), two groups had no significant difference (p=0.958). In the two groups were compared with group C (7.14±0.56days), there was no significant difference (p were0.132,0.132).3groups follow-up were complete, and no one died after discharge. Group A and group B had no statistical difference (p=0.849)in NYHA heart function classification, but compare with the group C there were statistically significant (p were0.033,0.033). Group A reduce the3.87mm after operation (P=0.005)on atrial diameter on average, the2.61mm (P=0.046) on average, the3.69mm (P=0.035)on average, the difference was statistically significant. While no significant change in left ventricular ejection fraction before and after surgery (P=0.466). Group B reduce the5.22mm (p<0.001) on atrial diameter on average, LVSd reduce1.06mm (p=0.027), LVDd reduce1.61mm (p=0.045), these differences have statistical significance. While there was also no significant change in left ventricular ejection fraction before and after surgery (p=0.167). Postoperative left atrial diameter of Group C reduce (p=0.005),6.55mm on average. LVSd (p=0.093), LVDd (p=0.068), left ventricular ejection fraction (p=0.888) before and after surgery had no significant change.Conclusion:the efficacy of bipolar and unipolar Saline-irrigated Radiofrequency Modified Maze Procedure combined with mitral vavle surgery for atrial fibrillation are the same.