| Objective:The goal of this study is to investigate the surgical results of bipolar radiofrequency ablations on treating atrial fibrillations, to compare the surgical results of treating mitral valve diseases with atrial fibrillation using bipolar radiofrequency ablations:left atrium plus simplified right atrium vs. left and right atria, and to explore the factors deciding patients’chance to restore sinus rhythm after surgeryMethods:All patients underwent surgery in our hospital from September2012to May2013due to mitral valve disease with atrial fibrillation were divided into two groups:23patients who were treated with left plus simplified right atrial ablation and22patients who were treated with biatrial ablations. All patients underwent cardiopulmonary bypass procedure to either replace or reconstruct mitral valve (with or without tricuspid replacement or reconstruction) while applying bipolar radiofrequency ablation during the same period. Both groups were analyzed and compared on ablation success rate and influencing factors of postoperative sinus rhythm restoration, including clinical data, ablation time, cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, postoperative mechanical ventilation time, ICU observation time, postoperative cardiopulmonary function recovery (postoperative echocardiography, ECG, NT-proBNP) and follow-up resultsResults:For all studied patients, there were neither perioperative deaths, nor low cardiac output syndromes, nor respiratory system and central nervous system complications. Both procedures resulted in positive effects. The immediate postoperative sinus rhythm restoration rate was97.8%as measured in ECG with one patient diagnosed as atrial tachycardia. The sinus rhythm restoration rate at hospital discharge was91.1%. The left atrial diameter was42.06±7.18mm during follow-up visit. The plasma NT-proBNP concentration was844.03±702.04pg/ml7days after surgery, statistically significant comparing to preoperative measurements (P<0.05). The group of patients with left and simplified right atrial ablations outperforms the other group in ablation time and cardiac function recovery speed with statistical significance (P<0.05). The two groups have no significant differences (P<0.05) in surgery bypass time, total operative time, postoperative left atrial diameter, left ventricular diameter and LVEF values. For the23patients with three month follow-up visits, the sinus rhythm restoration rate is91.3%. Among them, those had left and simplified right atrial ablations have a restoration rate of91.7%while those had biatrial ablations have a restoration rate of90.9%respectively. The difference is not statistically significant (P>0.5). Based on analysis with multiple risk factors, the preoperative left atrial size is the key factor to determine if the patient can restore sinus rhythm can after surgery.Conclusion:For patients with mitral valve disease and atrial fibrillation, it’s proven that applying bipolar radiofrequency ablation during cardiac surgery is safe and effective in restoring sinus rhythm after surgery. Both groups have high success rate to restore sinus rhythm while the group with left plus simplified right atrial ablation is less time consuming in ablation and faster in heart function recovery. After multiple risk factor analysis, it’s concluded that the preoperative left atrial size is the key factor to determine if the patient can restore sinus rhythm can after surgery. |
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