The Contrastive Study Of Two Paths Of Bipolar Radiofrequency Ablation Of Atrial Fibrillation During Mitral Valve Surgery——Bi-atrial Ablation Versus Left Atrial+simplified Right Atrial Ablation

Objective:To compare the two paths of bipolar radiofrequency ablation of atrial fibrillation during mitral valve surgery——Bi-atrial ablation versus left atrial+simplified right atrial ablation. Then, to explore the path of bipolar radiofrequency ablation of atrial fibrillation during mitral valve surgery as well as the factors affecting the success rate of bipolar radiofrequency ablation.Methods:72cases of mitral valve disease complicated by atrial fibrillation (and conform to inclusion criteria of this subject) who accepted surgical treatment in our hospital from October,2012December2013were divided into two groups:A:left atrial+simplified right atrial group(40cases), B:Bi-atrial group(32cases). All patients were performed mitral valve replacement/mitral valvuloplasty with or without Tricuspid valve plasty+bipolar radiofrequency ablation of atrial fibrillation under the CPB. Clinical data were collected, including demographic data (age, gender, height, weight, etc.), Preoperative and postoperative electrocardiogram, echocardiography and sternum, myocardial enzymology and other auxiliary examination; Intraoperative radiofrequency ablation time, extracorporeal circulation time, aorta blocking time, Electrocardiogram (ECG), echocardiography, chest X-ray data during the follow-up period. On the basis fo these date, we compared the effectiveness and security of the two kinds of operative methods and analyzed the factors affecting the success rate of bipolar radiofrequency ablation.Results:Two groups of patients had no perioperative death, also did not appear low cardiac syndrome、respiratory system or central nervous system complications, and two groups had no postoperative bleeding lead to open chest again. The immediate postoperative the sinus rhythm converting ratio of group A and group B were97.5%and96.88%, respectively.4cases of cardiac arrhythmias before hospital discharge in group A were happened, including atrial flutter in2cases, atrial fibrillation in1case, SVT in1case, sinus rhythm converting ratio was90.00%.3cases of cardiac arrhythmias before hospital discharge in group B were observed, including atrial flutter in2cases, SVT in1case, sinus rhythm converting ratio was90.63%. The application of temporary pacemaker in patients in group A was2cases, group B was3cases (both autonomous heartbeat back to more than70beats/min before discharge, dismantling temporary pacemaker), In addition, group B has1case of postoperative wound infection. Data of both groups in extracorporeal circulation time, aorta blocking time, postoperative left atrial、left interior diameter shortening degree, the degree of postoperative EF increase, respiratory quotient index, sinus rhythm converting ratio after operation and during follow-up period had no significant statistical difference (P>0.05). However, the NT-proBNP decline after surgery within7days, radiofrequency ablation time, postoperative4h of cardiac troponin T had significantly statistical differences (P<0.05) between two groups. Follow-up of3to17months, an average of10±4.5months,the sinus rhythm converting ratio of3months was88.06%, The corresponding date of6and12months were80.85%and86.49%, respectively.Conclusion:Both Bi-atrial ablation and left atrial+simplified right atrial ablation are safe and effective, Compared with the Bi-atrial ablation, the left atrial+simplified right atrial path has shorter ablation time, faster recovery of cardiac function and More slight damage to myocardium. In addition, preoperative left atrial diameter>60mm, history of atrial fibrillation>5years, NYHA heart function level>3are the important factors affecting the success rate of bipolar radiofrequency ablation.