The Experimental And Clinical Research Of Pulmonary Veins Isolated Of Patients Suffered From Rheumatic Heart Disease With Permanent Atrial Fibrillation

Objectives:To research on the effect of pulmonary veins(PV) isolated with radiofrequency endocardium ablation in patients suffered from rheumatic heart disease combining permanent atrial fibrillation(pAF), and to study the structure and neural changing of PV suffered from atrial fibrillation., the further to approach a preliminary relationship with pAF. Methods: (1) Animal experiment: Endocardial ablation surgery was performed on 3 pig hearts in vito by a self-made radiofrequency cycle with a set of suitable parameters. (2)Surgical ablation: 34 patients who suffered from rheumatic valves diseases and underwent mitral or mitral and aortic valve replacement were selected and divided into 2 groups, named ablating group (n=17) and control group (n=17). The pulmonary veins of ablating group patients were ablated with self-made cycle while the control goup was not. In 9.9±2.18 months'follow-up, all patients had ECG and cardiac echocardiography for internal left atrial diameter (LAD), and left ventricular ejection fraction (LVEF);(3) From the ablating group , we selected 14 patients as the permanent AF group, and 12 patients as the control group who were sinus rhythm. Myocardial specimens were acquired from the right superior pulmonary vein respectively during the surgery. HE stain was used to study PV histology. Western blot and Immunohistochemistry were used to detect expression and location of pgp9.5 respectively. Pgp9.5 mRNA expression was detected by RT-PCR method.Results: 1. The result of radiofrequency ablating pulmonary veins of patients suffered from rheumatic heart disease with pernanent atrial fibrillation1). The animal research demonstrated the security and availability of the self-maded cycle.2). The clinic baseline of the two groups and the time of cardiopulmonary bypass and aorta clamp have no significant difference in term of statistic (p>0.05). In ablating group, SR was achieved in 52.9% of patients during 9.9±2.18month follow-up, com- pared with 17.6% in control group. There has statistical significance(p=0.037) between the two groups.2. Histology of pulmonary vein and pgp9.5 expression study1). Results of histology and Immunohistochemistry:Compared with the sinus rhythm group, AF group PV muscle cells are more hypertrophy,and the arrangement of muscle bundles are broader.No specific pacemaker cell was found. The immunohis- tochemistrial stain is discovered with a lot of pgp9.5 expressive cell in two group of PV muscle sleeves cells and their fat pads and the two right atriums muscle cells. 2). Results of Western blot:The level of expression of pgp9.5 protein is no statistical significance among the 2 groups.Results of RT-PCR:The level of the expression of pgp9.5 mRNA is no statistical significance among the 2groups.Conclusions: (1) It is of security and availability using the self-disigned cycle. (2) radiofrequency ablation of pulmonary veins endocardium was efficacy to cure permanent AF with rhematic heart valves desease. (3) the arrangement of heart muscle bundles of AF are broader.There is no fingding specific pacemaker cell. (4) The level of expression of pgp9.5 has no change in permanent AF.