| Background and objective: AF, a frequent and banal arrhythmia, is a debilitat-ing and costly disease. The majority of patients with AF are aged 60 to 80 years, but the prevalence is as high as 10% after 80 years and the incidence increases in recent years in an "epidemic" way. AF is responsible for an excess of mortality with an relative risk between 2 and 4 depending of age and sex,specially as cardiovascular risk factors are associated.The morbidity is also important, with cerebral systemic embolism (2-3% per year), heartfailure (1 patient for 3), and a total risk of hospitalization from 20 to 30% per year for AF patients with high cardiovascular risks[1-3]. mitral stenosis and mitral insufficiency caused by rheumatic heart disease is the primary pathogenesis.most of the AF patients with rheumatic mitral valve disease in department of cardiac surgery were persistent or permanent atrial fibrillation,it has a long history with left atrial enlargement and hard to cure by drugs. And its treatment mainly with the primary disease treatment for surgery (mitral valve replacement, etc.), a maze III surgery, left atrial volume reduction surgery way, etc. Traditional maze procedure by multiple isolated pulmonary vein incision of left and right atrium from the broken cause of atrial fibrillation turn-back ring, the sinus electric excited by a special channel from the sinoatrial node to the atrioventricular node, to restore sinus rhythm and atrioventricular synchronization, the atrial fibrillation converting rate can reach more than 90%[4].Due to the complexity of the procedure for operation, trauma and perioperative complications,it has been gradually replaced by surgical radiofrequency ablation techniques[5]. With the traditional compared to "cut and sew" maze procedure, radiofrequency ablation surgery can significantly reduce the operation difficulty and trauma, but its success rate only about 70%[6].How to improve the surgical radiofrequency ablation of the curative effect of surgical treatment of atrial fibrillation is a big problem urgently to be solved in cardiac surgeons. In the previous study we found that maze Ⅲ Radiofrequency ablation technique with heart GP ablation is simple effective and easy to operate, and high success rate of surgery and the recurrence rate is low, However, the treatment of RFMM Ⅲ+GP ablation and pure RFMM Ⅲ was not reported. This study is to compared the curative effect of two methods and try to analysis the affects of AF to the tricuspid insufficiency in postoperation.Methods:A retrospective analysis was performed to analyze the clinical data of 200 patients who underwent RFMM Ⅲ plus GP ablation (n=100) or RFMM Ⅲ alone (n=100) in treatment of AF with rheumatic mitral lesion.during the perioperative period and 1-,6-and 12-month follow-ups were compared between the two groups respectively.Results:The sinus rhythm maintenance rates of the patients who underwent RFMM Ⅲ plus GP ablation were higher than those of the ones who underwent RFMM Ⅲ alone during the 1-,6-and 12-month follow-ups (P values were 0.03,0.02 and 0.03, respectively). In addition, the patients who underwent RFMM Ⅲ alone had a higher incidence of aggravating tricuspid regurgitation and more obvious left atria enlargement than the ones undergoing RFMM Ⅲ plus GP ablation during 12-month follow-up (P=0.03)Conclusions:RFMM Ⅲ plus GP ablation, with higher sinus rhythm maintenance rate and lower recurrence rate, might be superior to RFMM Ⅲ alone in treatment of AF with rheumatic mitral lesion. Moreover, RFMM Ⅲ plus GP ablation might effectively improve tricuspid regurgitation in patients undergoing mitral valve replacement and be beneficial for their long-term prognosis. Thus RFMM Ⅲ plus GP ablation, safe and effective. |
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