| Background:Atrial fibrillation（AF）is a common arrhythmia in clinic, its morbidity is0.15%－1.00%.Rheumatic mitral valve disease can predispose patients to persistent atrial fibrillation.In general,the atrial fibrillation will persist even after the valve surgery. There are many treatments foratrial fibrillation, but surgery cure of atrial fibrillation was highly concerned in Maze procedurein recent years. After improved for many times, bipolar radiofrequency ablation systemmodified Maze Ⅲ procedure is widely used as adjunctive therapy. The operation is a kind ofrapid, safe and effective technique，but it remains unclear whether this procedure impacts on theleft heart structure and function.Objective:To evaluate the modification of left heart structure and function before and after bipolarradiofrequency ablation system modified Maze Ⅲ procedure in patients with rheumatic heartvalve disease and atrial fibrillation by echocardiography. We aim to provide a non-invasive、cheap、convenient、repeated method to surgeon, and can evaluate the left heart structure andfunction by systematic、comprehensive、quantitative technique.Methods:In this study,55consecutive patients with rheumatic heart valve disease and atrialfibrillation were divided into two groups: trial group(underwent bipolar radiofrequency ablationsystem modified Maze Ⅲ procedure and valve surgery) and control group (underwent valvesurgery alone).Other20people with no disease were the healthy control group. There are3partsin echocardiography: routine measurements include left atrial diameter(LAD)、left ventricularend diastolic diamete（rLVEDd）、left ventricular end systolic diamete（rLVESd）、mitral annulusdiameter、mitral valve area（MVA）.Left atrial function datas include the peak velocity ofE-wave in early diastole(Ve)、the velocity-time integral of E wave(E-VTI)、the peak velocity ofA-wave in late diastole(Va)、the velocity-time integral of A wave(A-VTI)、left atrial fillingfraction(AFF)、the peak velocity of pulmonary vein valve in systole(S)、the peak velocity of pulmonary vein valve in early diastole(D)、the peak velocity of pulmonary vein valve in latediastole(Ar)、left atrial ejection force(LAEF)、the maximum volume of left atrial(LAVmax)、the minimum volume of left atrial(LAVmin)、the presystolic volume of left atrial(LAVp)、thetotal volume of left atrial(LAVtotal)、the active volume of left atrial(LAVact)、the passivevolume of left atrial(LAVpass). Left ventricular function datas include left ventricular enddiastolic volume(LVEDV)、left ventricular end systolic volume(LVESV)、stroke volume(SV)、cardiac output(CO)、left ventricular ejection fraction(LVEF)、fractional shortening(FS)、the peakvelocity of mitral annulus by tissue Doppler in systole(Sa)、 the peak velocity of mitral annulusby tissue Doppler in early diastole（Ea）、the peak velocity of mitral annulus by tissue Dopplerin late diastole（Aa）and myocardial performance index（Tei）. The parameters of patients in trialgroup and control group were evaluated by echocardiography in preoperative and postoperativeone month、three months and six months and statistical processing.Results:Before the surgery, left atrial diameter、left atrial volume and Ve in trial group and controlgroup were higher; LAEF、S and Ar were lower; Tei were bigger than in healthy control group（P＜0.05）. After the surgery, extracorporeal circulation minutes in trial group is longer thanin control group（P＜0.05）.Recovery rate of atrial fibrillation in trial group are significantlyhigher than in control group after the surgery one month、three months and six months（P＜0.05）. Left atrial diameter and volume were decreased than preoperative both in trial group andcontrol group, and more significantly in trial group（P＜0.05）.AFF、LAEF、S、LVEF、FS、Sa、Ea were higher than preoperative in trial group after the surgery six months（P＜0.05）;A、D and Ar were also higher than preoperative, but with no significant difference（P＞0.05）. Teiimproved after the surgery three months（P＜0.05）.Conclusions:The impact of atrial fibrillation on left atrial is more obviously than on left ventricular.When atrial fibrillation presents, left atrial diameter and volume increases, the systolic anddiastolic function were inconsistent, pressure of left atrial increases, blood from pulmonaryvenous to left atrial reduce and further those can affect cardiac function, reduced cardiacoutput.The addition of bipolar radiofrequency ablation system modified Maze Ⅲ procedure tovalve surgery for atrial fibrillation is safe、time-saving and effective. Recovery rate of atrial fibrillation is high. The procedure can help left atrial restore shape and function and worth topromotion in clinical. After the surgery, the diameter and volume of left atrial decrease. The leftheart function of patients who restore sinus rhythm were improved. The systolic and diastolicfunction were consistent and cardiac output increase. Addition of modified Maze Ⅲ procedurecan improve hemodynamic performance and reduce the incidence of thromboemboliccomplications. Echocardiography can reflect left heart function accurately. |
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