Clinical Research Of Different Bipolar Radiofrequency Ablation Surgical Methods In The Surgical Treatment Of Atrial Fibrillation Concomitant Valve Replacement

Objective:To study the security and efficacy of the different surgical methods of bipolar radiofrequency ablation to treat atrial fibrillation combined with rheumatic heartOur research had three parts.Part I: To estimate the effect of valvular replacement with bipolar radiofrequency ablation on the postoperative cardiac function with retrospective analysis. Clinical data of 191 cases diagnose with atrial fibrillation combine with rheumatic heart disease from January 2011 to December 2011 were involved retrospectively. In the control group, 93 cases were underwent cardiac valve replacement, and in the experimental group,98 case were underwent cardiac valve replacement combined with bipolar radiofrequency ablation. The echocardiography and electrocardiogram and complications after surgery were followed-up 6 months, 1 years, 2 years post-discharge by telephone, letters and other method.Part II: To analyze the early curative effect of different surgical methods of bipolar radiofrequency ablation to treat atrial fibrillation combined with rheumatic heart disease with retrospective analysis. A total of 197 patients underwent valve replacement concomitant bipolar radiofrequency ablation from May 2011 to December 2011 in the department of cardiovascular surgery of Xinqiao hospital. Patients were divided into the biatrial ablation group(totally biatrial radiofrequency ablation) and simplified right atrial ablation group( left atrial and simplified right atrial radiofrequency ablation). Clinical data collection was the same with the part I.Part III: To study the security and efficacy of the different surgical methods of bipolar radiofrequency ablation to treat atrial fibrillation combined with rheumatic heart disease with prospective analysis. A randomized, open-minded, parallel-group study was conducted to compare the efficacy of biatrial ablation and simplified right atrial ablation. Clinical date of 73 patients underwent valvular replacement concomitant bipolar radiofrequency ablation from March 2012 to February 2013 in the department of cardiovascular surgery of Xinqiao hospital were collected. And the doppler echocardiography and electrocardiogram and complications were followed-up 3、6、12、18、24 months after surgery.Results:Part I: There was no death, cardiac rupture or application of permanent cardiac pacemaker in patients of our follow-up studies. The fractional shortening and Ejection Fractions results and the rate of consciously improved cardiac function of patients in first and the first two years after surgery showed the homochronous ablation group was higher than the control group.Part II: Compared the left atrial and simplified right atrial ablation group with the biatrial ablation group, No significant differences in complications of peri operation period;we found that the preoperative clinical data,the sinus rhythm conversion rate and the echocardiography examination results in the first day, first six months, first 12 months after surgery had no significant difference.Part III: The preoperative clinical data of patients in these two grouos had no significant difference. There was no significant difference of sinus rhythm conversion rate and echocardiography examination results between these two groups. However, the aortic cross-clamp time, ablation time, operative bleeding and the thoracic cavity drainage in the 24 hours after surgery of the simplified right atrial ablation group were significantly less than the biatrial ablation group.Conclusions1. Heart valve replacement and concomitant bipolar radiofrequency for atrial fibrillation is safe and sinus rhythm rate was significantly higher than that of single valve replacement, and the cardiac function of the early and mid-term after the operation improves.2. Review and prospective study showed that the valve replacement concomitant left atrial and simplified right atrial bipolarl radiofrequency ablation for AF can achieve similar early and mid efficiency as biatrial ablation;valve replacement concomitant left atrial and simplified right atrial bipolarl radiofrequency ablation had the less aortic cross-clamp time, ablation time and operative and postoperative bleeding as biatrial ablation;...