Efficacy Of Atrial Fibrillation With Monopole Radiofrequency Ablation In Valve Replacement Under CPB

Objective: To evaluate the clinical efficacy of valvular heart disease with atrial fibrillation under Under open-heart CPB monopolar radiofrequency ablation flushing.Methods:For January 2011 to December 2013 period, Ningxia Medical University General Hospital Heart Center of Vascular Surgery, valvular heart disease clinical data of 110 cases of patients with atrial fibrillation, explore the clinical characteristics and clinical experience.Observation CPB time, aortic cross-clamping time, sinus rhythm recovery after surgery the same day, early postoperative complications, postoperative one week to review the results of 12-lead ECG and echocardiography examination.Recovered through outpatient follow-up after hospital discharge and( or) telephone follow-up. The follow-up time was 6 months to 9 years.By ECG, analyzing of rhythm after recovery of heart beat. Analysis of left atrial radiofrequency modified maze unipolar flushing cardioversion sinus ablation rate factors.Results:110 cases of heart valve disease in patients with atrial fibrillation in 41 males and 69 females, aged 50. 93 ± 8. 94 years old, with an average weight of 58.51 ± 9.07 Kg.A history of atrial fibrillation in January-142 months(mean 31.53 ± 31.17 months).The whole group of 110 patients were successfully operated, aortic clamping time 25-180 min, the average(79.42 ± 32.48) min, CPB time 64- 266 min, the average(127.32 ± 40.66) min. Of which 88 cases of pure mitral valve replacement, a simple two cases of aortic valve replacement, mitral valve replacement and aortic valve replacement surgery in 20 cases, 79 cases of tricuspid annuloplasty, left atrial thrombus dissection 35 cases(including thrombotic located in the left atrial appendage 19 cases), left atrial plication two cases.Radiofrequency ablation group did not undergo postoperative day 41 cases were converted to sinus rhythm 13 cases( 31.71%), but converted to atrial fibrillation in 3 patients during the postoperative hospital stay, just one week after reviewing 10 cases electrocardiogram( 25.64. %) remained sinus rhythm. All the patients were clinically cured 105 cases( 93.91% cure rate), 5 cases of early postoperative death( mortality rate 3.48%).Early postoperative 1 patient during hospitalization occur Transient ischemic attack(TIA), giving improve circulation, improved and discharged after lipid-lowering therapy. Radiofrequency ablation in patients without Ⅲ ° atrioventricular block, or need to install a permanent pacemaker patients. Postoperative by telephone and( or) outpatient follow-up. Follow-up results : after 12 months to 4 years of 71.88%( 46/64 patients) to maintain sinus rhythm. Without radiofrequency ablation group were followed up in December-48 months cardioversion to sinus rhythm was 15.95%( 6/39 cases). During follow-up radiofrequency ablation in patients with preoperative age <60 years, history of atrial fibrillation < 36 months, no left atrial thrombus and left atrial diameter <60mm high cardioversion to sinus rhythm.Conclusion:1.Monopolar radiofrequency ablation line flush left atrial maze improved treatment of heart valve disease in patients with atrial fibrillation, high security, high success rate, complications and surgical risk is low. The surgical approach to sinus rhythm early cardioversion rate, good effect, there are promotional value. But still need to observe the long-term effect on clinical practice.2.Valvular atrial fibrillation patient age, history of atrial fibrillation, left atrial thrombus and presence of preoperative left atrial diameter. These factors affect the concomitant valve replacement under CPB monopolar radiofrequency ablation flushing to maintain efficacy in patients with sinus rhythm.