| Atrial Fibrillation (AF) is a kind of arrhythmia characterized by rapid and irregular artrial impulses and ineffective atrial contractions. It is clinically the most common arrhythmia, and the most common complication after cardiac surgery. Then, the treat strategy of AF is critical to the recovery and prognosis after cardiac surgery. Till now there are several chooses for AF such as durgs, electronic conversion, Transcatheter radio frequency and surgical treatments, among which the Cox-Mazeâ…¢procedure had an achievement ratio upto 80-90%, it has been accepted as the golden stander of surgical treatment of AF. Bipolar radiofrequency ablation modified Mazeâ…¢operation (also called Mazeâ…£operation) simplified operation procedure and ischemia time during operation greatly, come out with a high conversion rate. The AF recurrence and AF/SR exchanges were detected after the operation. The unique pharmacologic actions of amiodarone promised prophylactic and therapeutic effects against AF, but its multiply side effects even severs complications coexisted. By now, almost all the cardiac surgery centers treat AF with amiodarone , positive results had been disused. In light of multiply side effects of amiodarone and too much patients'burden, whether amiodarone treatment after modified Mazeâ…¢operations is necessary and its'usage strategy need further investigate.Purpose: to investigate the necessity of amiodarone treatment after bipolar radiofrequency ablation modified Mazeâ…¢operation against AF. To investigate clinical strategy of amiodarone treatment after bipolar radiofrequency ablation modified Mazeâ…¢operation.Method: to investigated a group of 52 cases continuously performed of radio frequency modified Mazeâ…¢operations in the second hospital of Jilin University since May 2005 to Dec. 2008. Amiodarone treatment did not performed without atrial fibrillation recurrence. When AF recurrent, firstly intravenous inject amiodarone 75mg , then maintain the dose of 60mg/h by micro-pump intravenously, intravenous usage of amiodarone no more than 3 days. After tracheal cannula removed, orally took amiodarone 0.6g per day. If AF persisted, orally took amiodarone 0.6g per day continuously no longer than 6 months. If it converse to sinus rhythm , orally took amiodarone reduced to 0.4 per day after 2 weeks , 0.2g per day after 4 weeks, withdrawal amiodarone till 6 weeks. The preoperational data (sex, age, AF duration, Left atrium diameter, EF value , f value height , NYHA classification). The accumulated dosage and treatment time of amiodarone until discharge were collected. Complications (bradycardia need pacing maker or drugs assist , drainage). Follow up by telephone and clinic, to find out the sinus rhythm conversion rate of 1month , 3month ,6month, 1year, 2year, 3year and 4year after operation.Result : in the operation after heart repumping , there were 2 cases of AF, and other 50 cases were all sinus rhythm. There were 9 cases without AF recurrence therefore without amiodarone treatment. Failed to follow up of 1 case. Others 8 cases followed up to 1month , 3months, 6months , 1year, 2years, 3years, 4years, the conversion rate were 87.5%,87.5%,100%, 87.5%,100%,100%,75%,100% separately. In the early period (1-3 months) after cardiac surgery, the conversion rate was about 70-80%, 6 month after operation conversion rate gradually grew up to 80-90% and stayed around. The conversion rate could up to over 90%, within following up 3,4 year cases. The first 2-3 days after operation was identified as the high AF recurrent period. There was a relatively high risk(18%) of bradycardia after postoperational amiodarone treatment, but prognosis came out well with proper treat.Conclusion : (1) Prophylactic treatment with amiodarone is not necessary when on AF recurrence. (2) The first 2-3 days after bipolar radiofrequency ablation modified Mazeâ…¢operation was identified as the high AF recurrent period, when the amiodarone treatment should be efficiency. (3)Our amiodarone treatment strategy showed an obvious enhance of SR conversion rate, when performed at recurrence of AF after the operation.(4)The best opportunity and dosage of amiodarone applying after bipolar radiofrequency ablation modified Mazeâ…¢operation need further investigate.
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