Risk analysis on postoperative recurrence of atrial fibrillation after bipolar radiofrequency ablation undergoing open heart procedures / 中华胸心血管外科杂志

ABSTRACT

ObjectiveSurgical radiofrequency (RF) ablation has recently been one of the most effective means to treat chronic atrial fibrillation(AF).However,about 20％ to 30％ patients have shown recurrence of AF during the follow-up period.This study retrospectively analyzed AF recurrence rate in those patients who underwent valve replacement procedures combined with RF ablation to treat AF in our department during the last three years.We compared the information and clinical date in the sinus rhythm(SR) group with in the AF recurrence group to analyze the relationship between various preoperative risk factors and operation failure.The aim of this study is to provide evidences to select patients who can benefit most from this type of surgery and to reduce their surgical risk and hospital charges.MethodsFrom June 2006 to June 2009,52 patients with rheumatic heart disease (RHD) and chronic AF underwent RF ablation concomitant with valve replacement in our department by a same surgeon with the same method.Preoperative and intraoperative data was retrospectively collected and all patients were followed up longer than six months to determine the type of heart rhythm.Operation failure was defined as showing any rhythm except normal sinus rhythm by electrocardiogram.We divided all patients to the SR grope and AF grope.Univariate and multivariate statistical analysis was used to compare the data between the two groups in pre-,intra- and postoperative period.Results There was only one case in-hospital mortality ( 1.9％ ).None mortality,re-exploration for bleeding and pacemaker implantation for malignant arrhythmia was shown during the mean follow-up period of 14 months (9-35 months).At the last follow-up,sinus rhythm was shown in 71.2％ (37/52) patients.In univariaye analysis,the left atrial diameter,AF duration,left ventricular end diastolic volume and aortic cross-clamp were predictors of recurrence of AF.Age,left ventricular ejection factor,cardiopulmonary bypass time showed no significant difference between the two gropes.Multivariate analysis showed that AF duration was the independent risk factor of recurrence of AF after the bipolar radiofrequency ablation procedure.ConclusionRF ablation concomitant with valve replacement is an effective way to treat AF for those patients who need open heart surgery at the same time.Patients with normal SR may gain a better life quality.Preoperative duration of AF was the independent risk factor of AF recurrence.The longer the duration of AF is,the worse the efficacy of this procedure to restore normal SR is.