The Study On Medication Therapy And Electric Defibrillation To Permanent Atrial Fibrillation In Post-prosthetic Cardiac Valve Replacement Patients

Objective:Atrial fibrillation(AF) are presented mostly in patients with organic heart diseases, commonly due to rheumatic valvular diseases. Treatment of AF involves two strategies:"rate control" strategy and "rhythm control" strategy. For decades, permanent AF(duration>1year) has been considered hard to convert or maintain the sinus rhythm. Over40%of patients who received mitral surgeries have permanent AF, even when the blood dynamics apparently improved and the symptoms released in post-operations. After the valve replacement surgeries remove the valvular organic lesions, cardiac function is gradually improved, enlarged heart recovered and the cardiothoracic ratio close to normal. Once the incentives of AF is removed, the pressure of atrium and the left atrial diameter (LAD) gradually reduces. In that case, AF can be converted into sinus rhythm, the study enrolled permanent AF patients who had received prosthetic valve replacement surgeries in Lanzhou University Second Hospital from July2006to June2012and whose hearts had recovered close to normal size in post-operation time. These patients were randomly selected for electrical reversion vs pharmacological conversion in order to find a better strategy.Methods:1)The study comprised136patients who suffered permanent atrial fibrillation after mitral with or without aortic valvular replacement in Lanzhou University Second Hospital from2006to2012. During surgery, Some patients conversion to sinus rhythm automatic, For patients who were not conversion given electrical reversion,Their clinical data and follow-up data were analyzed.2)The study comprised119patients who suffered permanent atrial fibrillation after mitral with or without aortic valvular replacement in Lanzhou University Second Hospital from2006to2012, In the Postoperative recovery period (about6-12months), Give DC synchronized cardioversion therapy. Their clinical data and follow-up data were analyzed3)The study comprised115patients who suffered permanent atrial fibrillation after mitral with or without aortic valvular replacement in Lanzhou University Second Hospital from2006to2012. Patients were randomly divided into two groups. In their recovery phase when the size of hearts close to normal, group1were given electrical reversion and group2with amiodarone orally medication. Reversion rate and recurrence rate were calculated after.Results:1) During surgery,47patients conversion to sinus rhythm automatic, For89patients who were not conversion given electrical reversion, A total of20patients were cured at discharged.2) A total of104patients conversion to sinus rhythm, The reversion rate was87.3%.87patients were cured at discharged, The Cure rate was73.1%3) The reversion rate of group1and group2was98.3%(58/59) and26.8%(15/56) respectively. The electrical conversion was apparently more efficient (p<0.01). However, their recurrence rate showed no statistical significance, with group1for3.4%and group2for6.7%. In addition, no patients who once received treatments ended up with death and severe complications in this researchConclusions:We proposed that electrical reversion in recovery phase would be a simple, safe and efficient way to treat permanent atrial fibrillation after cardiac valvular replacement.