Comparison Of Unipolar And Bipolar Radiofrequency Ablation For Treating Atrial Fibrillation In Elderly Patients

Objective To compare advantage and defect of unipolar radiofrequency ablation and bipolar radiofrequency ablation for atrial fibrillation(AF) in heart valve replacement surgery,To compare clinical effect of unipolar radiofrequency ablation and bipolar radiofrequency ablation for treating AF among elderly patients and discuss the correlated risk factors of bipolar radiofrequency ablation for AF, to evaluate the clinical effect of bipolar radiofrequency ablation for treating AF.Methods From October 2008 to December 2013, a total of 50 elderly patients of organic heart disease combined AF underwent radiofrequency ablation surgery, men in 19 and women in 31, the aged 65 ~ 77(67.4±3.3). All the AF elderly patients were divided into different two groups by operation methods, unipolar radiofrequency ablation was performed in 20 patients(groups A), bipolar radiofrequency ablation was performed30 patients(groups B). Group A: men in 6 and women in 14. AF duration(120.7±91.7) months; ultrasonic cardiogram(UCG): LAD(55.6±9.2) mm, LVEF(59.4± 5.8) %. Group B: men in 13 and women in 17. AF duration(73.3±64.3)months; UCG: LAD(51.9±8.9) mm, LVEF(59.2±8.4) %.The follow-up of the patients were adopted outpatient and telephone. Their variations of electrocardiogram(ECG) and ultrasonic cardiogram(UCG) were collected and the complications and the NYHA class of the patients were recorded in 3, 6 and 12 months after surgery. To observe sinus rhythm and cardiac function recovery, and record related complications and postoperative quality of life.The total of 43 elderly patients in 12 months after surgery were divided into sinus group and non-sinus group according to the results oftheir ECG. We used statistical methods to analyzed the difference of the related factors between the two groups.Results1. From 2009 to 2014, a total of 43 patients had been followed, the follow-up rate was 86.00%, Groups A was 18 cases, Groups B is 25 cases. In the Groups A,Cardiopulmonary bypass time(101.7 + 46.6) min, Aortic cross clamp(64.8 + 22.1)min. To observe recovery rates of sinus rhythm in 3, 6 and 12 months after surgery,respectively, unipolar groups were 73.7%(14/19), 66.7%(14/19)and 61.1%(11/18).Postoperative 1 case death, 2 cases thoracotomy surgical exploration, 4cases III degree atrioventricular block, 4 cases cerebral infarction, 2 cases Intractable low cardiac output, 1 case permanent pacemaker implantation. In the Groups B, Cardiopulmonary bypass time(127.7 + 51.2) min, Aortic cross clamp(76.1 + 30.9) min, In 3, 6 and 12 months after surgery, bipolar groups were 82.8%(24/29), 85.2%(24/29) and 88.0%(22/25). Postoperative 1 case death, 2 cases thoracotomy surgical exploration, 1 case III degree atrioventricular block, 2 cases cerebral infarction, 1 case Intractable low cardiac output, 0 case permanent pacemaker implantation. Two groups of the recovery rates of sinus rhythm in 12 months had a large difference in statistics. Group A(55.0%) had significant higher complication incidence than group B(55.0%) and two groups had a large difference in statistics.2. In Cardiac function recovery: echocardiography instructed two groups postoperatiive ultrasonic values(LAD, LVDD, PASP, LVEF), compared with preoperative, were significantly decreased and this difference was statistically significant(P < 0.05). Two groups of the differences of preoperative and postoperative were statistically significant(P < 0.05) among cardiac function(NYHA) classification I ~ IV.3. The total of 43 elderly patients in 12 months after surgery were divided into sinus group and non-sinus group. Atrial fibrillation and flutter, rhythm and permanent cardiac pacemaker in patients are classified as the non-sinus rhythm group. In risk factors of the sinus rhythm converting rate, Preoperative history of AF and left atrial diameter were influence factors of the sinus rhythm recovery rates, univariate analysis or multivariate analysis results show that they all had a significant difference(P <0.05).Conclusions(1) Bipolar radiofrequency ablation for AF is safe, less complications and high success rate of restoring sinus rhythm.(2) Including postoperative cardiac function and the quality of life, two groups are all statistically significant.(3) The patients with long preoperative history of AF and left atrium distension have a low success rate of restoring sinus rhythm and high recurrence rate.