Effect of mitral valve replacement with unipolar radiofrequency ablation of atrial fibrillation

Year 2013, Volume: 2 Issue: 3, 213 - 218, 01.09.2013

Gündüz Yümün Tamer Türk Yusuf Ata Derih Ay Faruk Toktaş Arif Gücü Cüneyt Eriş Şenol Yavuz

Abstract

Objective: The aim of this study is to investigate the effectiveness of unipolar radiofrequency ablation in patients with persistent atrial fibrillation undergoing mitral valve replacement. Method: Our study consists of 22 patients, who performed mitral valve replacement with associated left atrial ablation in our clinic between January 2010 and January 2012. Postoperative early and mid-term follow-up of the patients were retrospectively evaluated with 12-lead electrocardiographic recordings. The patients were followed up during 6- month period. Results: After cardiopulmonary bypass, 14 63.6% patients maintained normal sinus rhythm, 8 patients including one patient with a temporary pace support has AF on time received to the intensive care unit. In the early period, one patient died due to low flow, and prolonged intubation. At the end of the first month, 15 71.4 % patients were in sinus rhythm, and 6 patients 28.6% were with atrial fibrillation persisted. Followed by the tenth postoperative atrial fibrillation in a patient was implanted permanent pace. At followup 6th month, there was recurrent atrial fibrillation.Conclusion: The success achieved with the unipolar radiofrequency left atrial ablation was found to be consistent with the findings of the literature. In our study, patient age and pulmonary hypertension was evaluated as predictive of ongoing postoperative AF.

Keywords

Atrial fibrillation, Mitral valve replacement, Radiofrequency ablation

Mitral Kapak Replasmanı ile Beraber Unipolar Radyofrekans Ablasyonun Atriyal Fibrilasyon Üzerine Etkisi

Abstract

Amaç: Bu çalışmanın amacı mtiral kapak replasmanı uygulanan persistan atriyal fibrilasyonlu AF hastalarda unipolar radyofrekans ablasyon etkinliğinin araştırılmasıdır. Yöntem: Çalışmamıza, Ocak 2010- Ocak 2012 tarihleri arasında kliniğimizde mitral kapak replasmanı uygulanan ve beraberinde sol atriyal ablasyon uygulanan 22 hasta dahil edildi. Hastaların postoperatif ve orta dönem kontrol 12 derivasyonlu EKG kayıtları geriye dönük olarak değerlendirildi. Hastaların operasyon sonrası 6 ay boyunca takip edilmesi planlandı. Bulgular: Kardiyopulmoner bypass çıkışında 14 %63,6 hastada normal sinüs ritmi sağlandı, 1 hasta geçici pace desteğinde olmak üzere 8 36,3 hasta AF ile yoğun bakıma alındı. Erken dönemde 1 hasta düşük debi ve uzamış entübasyon nedeniyle kaybedildi. 1.ay sonunda 15 hasta %71,4 sinüs ritminde, 6 hastada % 28,6 atriyal fibrilasyon devam etmekteydi. Atriyal fibrilasyon ile takip edilen bir hastaya postoperatif 10. ayında kalıcı pace implante edildi. 6.ay sonunda tekrarlayan atriyal fibrilasyon olmadı. Sonuç: Sol atriyal unipolar radyofrekans ablasyon tedavisinde elde edilen başarı literatür bulguları ile uyumlu olarak bulundu. Çalışmamız sonucunda, hasta yaşı ve pulmoner hipertansiyon postoperatif devam eden AF için prediktif olarak değerlendirilmiştir.

Keywords

Atriyal fibrilasyon, Mitral kapak replasmanı, Radyofrekans ablasyon

References

• Cox JL, Schuessler RB, D'Agostino HJ, Jr., Stone CM, Chang BC, Cain ME, et al. The surgical tre- atment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardio- vasc Surg. 1991 Apr;101(4):569-83.
• Cox JL, Ad N, Palazzo T, Fitzpatrick S, Suyder- houd JP, DeGroot KW, et al. Current status of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg. 2000 Jan;12(1):15-9.
• Scheinman MM, Morady F, Hess DS, Gonzalez R. Catheter-induced ablation of the atrioventricu- lar junction to control refractory supraventricu- lar arrhythmias. JAMA. 1982 Aug 20;248(7):851- 5.
• Williams MR, Stewart JR, Bolling SF, Freeman S, Anderson JT, Argenziano M, et al. Surgical tre- atment of atrial fibrillation using radiofrequency energy. Ann Thorac Surg. 2001 Jun;71(6):1939- 43; discussion 43-4.
• Chen MC, Chang JP, Guo GB, Chang HW. Atrial size reduction as a predictor of the success of radiofrequency maze procedure for chronic at- rial fibrillation in patients undergoing concomi- tant valvular surgery. J Cardiovasc Electrophy- siol. 2001 Aug;12(8):867-74.
• Sie HT, Beukema WP, Misier AR, Elvan A, Enne- ma JJ, Haalebos MM, et al. Radiofrequency mo- dified maze in patients with atrial fibrillation undergoing concomitant cardiac surgery. J Tho- rac Cardiovasc Surg. 2001 Aug;122(2):249-56.
• Handa N, Schaff HV, Morris JJ, Anderson BJ, Ko- pecky SL, Enriquez-Sarano M. Outcome of valve repair and the Cox maze procedure for mitral regurgitation and associated atrial fibrillation. J Thorac Cardiovasc Surg. 1999 Oct;118(4):628- 35.
• Raanani E, Albage A, David TE, Yau TM, Armst- rong S. The efficacy of the Cox/maze procedure combined with mitral valve surgery: a matched control study. Eur J Cardiothorac Surg. 2001 Apr;19(4):438-42.
• Cox JL, Schuessler RB, Lappas DG, Boineau JP. An 8 1/2-year clinical experience with surgery for atrial fibrillation. Ann Surg. 1996 Sep;224(3):267-73; discussion 73-5.
• Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, et al. Spontaneous initia- tion of atrial fibrillation by ectopic beats origi- nating in the pulmonary veins. N Engl J Med. 1998 Sep 3;339(10):659-66.
• Nitta T, Imura H, Bessho R, Hosaka H, Yamauchi S, Tanaka S. Wavelength and conduction inho- mogeneity in each atrium in patients with isola- ted mitral valve disease and atrial fibrillation. J Cardiovasc Electrophysiol. 1999 Apr;10(4):521- 8.
• Sueda T, Nagata H, Orihashi K, Morita S, Okada K, Sueshiro M, et al. Efficacy of a simple left at- rial procedure for chronic atrial fibrillation in mitral valve operations. Ann Thorac Surg. 1997 Apr;63(4):1070-5.
• Mohr FW, Fabricius AM, Falk V, Autschbach R, Doll N, Von Oppell U, et al. Curative treatment of atrial fibrillation with intraoperative radi- ofrequency ablation: short-term and midterm results. J Thorac Cardiovasc Surg. 2002 May;123(5):919-27.
• Usui A, Inden Y, Mizutani S, Takagi Y, Akita T, Ueda Y. Repetitive atrial flutter as a complica- tion of the left-sided simple maze procedure. Ann Thorac Surg. 2002 May;73(5):1457-9.
• McCarthy PM, Gillinov AM, Castle L, Chung M, Cosgrove D, 3rd. The Cox-Maze procedure: the Cleveland Clinic experience. Semin Thorac Car- diovasc Surg. 2000 Jan;12(1):25-9.
• Arcidi JM, Jr., Doty DB, Millar RC. The Maze pro- cedure: the LDS Hospital experience. Semin Thorac Cardiovasc Surg. 2000 Jan;12(1):38-43.
• Kamata J, Kawazoe K, Izumoto H, Kitahara H, Shiina Y, Sato Y, et al. Predictors of sinus rhythm restoration after Cox maze procedure concomi- tant with other cardiac operations. Ann Thorac Surg. 1997 Aug;64(2):394-8.
• Pasic M, Bergs P, Muller P, Hofmann M, Grau- han O, Kuppe H, et al. Intraoperative radi- ofrequency maze ablation for atrial fibrillation: the Berlin modification. Ann Thorac Surg. 2001 Nov;72(5):1484-90; discussion 90-1.
• Doll N, Borger MA, Fabricius A, Stephan S, Gummert J, Mohr FW, et al. Esophageal perfo- ration during left atrial radiofrequency ablation: Is the risk too high? J Thorac Cardiovasc Surg. 2003 Apr;125(4):836-42.