Analysis Of Bipolar Radiofrequency Ablation In Treatment Of Atrial Fibrillation

Objective: To summarize the outcomes of simultaneous bipolar radiofrequency ablation in patient undergoing cardiac valve replacement, and analyze the relationship between various preoperative risk factors and operation failure. Methods: From November 2009 to April 2014, 219 patients( 53 males and 166 females, aged 20-74 years old, mean 46.80±10.03 years old)with atrial fibrillation(AF) were studied retrospectively, who received radiofrequency ablation and valve replacement in Guizhou Provincial People’s Hospital. Preoperative electrocardiography and transthoracic echocardiography were performed to obtain the data of the rhythm and heart function. The procedures of the radiofrequency ablation were the same in all patients. The patients were followed up for more than 6 months and recieved periodic postoperative electrocardiography and 6-month oral amiodarone. It was identified being free from AF when electrocardiogram showed sinus P wave. According to the results of ECG,We dividedall patients to the SR grope and no SR grope. Statistical analysis was used to compare the data between the two groups in pre,intra-and postoperative period. Results: The duration of cardiopulmonary bypass is 83-243(124.80±36.04)minutes, aortic cross-clamping time was 65-304(103.86±31.59)minutes,the volume of blood loss during operation was 100-1500(710.00±281.79)ml, postoperative respirator use time is 1.5-167(12.47±17.42)hours, postoperative ICU time is 12-408(28.59±33.79)h, The time of hospitalization after operation is 6-41(14.14±5.05)day. 5.48%(12/219) patients died during perioperative or postopetative time, among them, death from intraoperative low cardiac output is 2 cases, postoperative low cardiac output is 3 cases, postoperative malignant arrhythmia is 3 cases, postoperative multiple organ failure is 3 cases,postoperative the posterior wall of the bleeding heart is 1 cases. Among 207 cases who exclude surround operation period death cases, 1.45%(3/207)is open chest for hemostasis again, 1.45%(3/207)is acute renal failure, 2.90%(6/207)operation incision is poor healing, 31.88%(67/207)used temporary pacemaker. Sinus rhythm(SR) was maintained in 79.00%(173/219) and non-SR in 15.53%(34/219) when discharged. 83.57%(173/207) cases were followed up and 16.42%(34/207)were lost. During follow-up(range 6 ~ 58 months,average 27.96±15.57months), 1.73%(3/173)patients died, and SR was maintained in 89.02%(154/173), meanwhile non-SR in 10.98%(34/173). Univariate analysis revealed that the left atrial diameter(LAD)、age and hypertension were risk factors affecting the outcome(P<0.05). Conclusion: Simultaneous bipolar radiofrequency ablation is effective and safe in treating AF when undergoing cardiac valve replacement. Patients with a larger preoperative LAD 、older age or hypertension have a poor outcomes.