Influence of left atrial dimension on the effectiveness of heart valve replacement combined with dipolar radiofrequency ablation in atrial fibrillation / 中国医师进修杂志

ABSTRACT

Objective To analyze the influence of left atrial dimension (LAD) on the effectiveness of heart valve replacement combined with dipolar radiofrequency ablation in atrial fibrillation (AF). Methods Eighty-one patients with permanent AF and heart valve diseases having undergone surgical treatment were selected. The patients were divided into two groups according to the size of LADgroupⅠ (45 patients with LAD<60 mm) and group Ⅱ (36 patients with LAD ≥60 mm). All the patients underwent heart valve replacement and douching dipolar radiofrequency ablation, and were given amiodarone therapy after operation. The ultrasonic cardiogram and electrocardiogram after operation were inspected periodically. The changes of cardiac function and electrophysiology activity were observed. The patients were followed up for 12 months. Results The early-stage mortality after operation was 3.7% (3/81), and all of death was caused by postoperative low cardiac output syndrome. Two cases appeared third-degree atrioventricular block after surgery, and they were installed permanent pacemaker. During the follow-up, 1 case died because of sudden cerebrovascular accident. Two cases were loss to follow-up. There was no statistical difference in rate of maintaining sinus rhythm at discharge from hospital between group Ⅰ and group Ⅱ 75.0% (33/44) vs. 73.5% (25/34), P=0.88. But the rates of maintaining sinus rhythm at 3 and 12 months after operation in groupⅠwere significantly higher than those in groupⅡ81.4% (35/43) vs. 58.8% (20/34) and 88.1% 37/42) vs. 60.6% (20/33), and there were statistical differences ( P=0.029 and 0.006). Conclusions For the patients in permanent AF and heart valves diseases with LAD <60 mm, the dipolar radiofrequency ablation during heart valve replacement has considerably beneficial effects on rate of maintaining sinus rhythm. But for the patients with LAD≥60 mm, the result is not optimistic and has a lower postoperative sinus rhythm restoration rate.