| Objective : Observation on the long-term efficacy of patients with atrial fibrillation who have heart surgery and the single pole radiofrequency ablation modified maze procedure, make a comprehensive and systematic analysis for the actors which may affect the prognosis of patients,explore and analyse the clinical value of the single pole radiofrequency ablation modified maze operation.Methods : From January 2003 to December 2013, there are 116 cases for the patients who have heart surgery and the single pole radiofrequency ablation modified maze operation in cardiac surgery chief physician Wang Yun group of Ning Xia medical university affiliated general hospital(47 males and 69 females, aged 26-73 years old, mean 50.04±9.42 years old, atrial fibrillation history of 0.1-30 years, mean 7.43±9.93 years). All the patients have persistent atrial fibrillation. There are 16 mitral valves disease combined with thrombosis in left atrium, 1 single aortic valves disease,2 single tricuspid valves disease, 43 mitral valves disease combined with tricuspid valves disease, 10 mitral valves disease combined with tricuspid valves disease and thrombosis in left atrium,8 mitral valves disease combined with aortic valves disease, 28 mitral valves disease combined with aortic valves disease and tricuspid valves disease, 1 tricuspid valves disease combined with ASD disease, 2 mitral valves disease combined with tricuspid valves disease and ASD disease, 2 ASD disease, 1 VSD disease, 2 mitral valves disease combined with coronary artery disease and thrombosis in left atrium. We do the single pole radiofrequency ablation modified maze operation on all patients with the machine called Medtronic Cardioblate TM 60880 include MVR 102, MVP 3, AVR 23, AVP 6, TVP devega 72, ASD suture 5, VSD suture 1, Left atrial thrombectomy 28, Left atrial appendage closure 19,CAGB 2.Intravenous pump amiodarone to the patients whose heart rate is more than 90 times/min. When the patients can take the medicine by mouth, oral instead,400mg/d,2 weeks later reduce to 200 mg/d, according to the rhythm and rate of hearts last for 6 months.Follow-up electrocardiography and color Doppler echocardiography are performed postoperatively 3-120 months by telephone or out-patient deparment. Analyze the relevant data detailedly with the statistical method.Results: Cardiopulmonary bypass time is 86-211 min, mean 118.5±26.2 min. Aortic resistance closed time is 46-131 min, mean 69.2±20.4 min. Radiofrequency ablation time is 10-40 min, mean 23±12.4 min. When the cardiopulmonary bypass is over,98 people’s hearts can beat by itself and 18 people’s hearts can beat by electric shock. In the end of the operation, 100 people are sinus rhythm and 4 people are nodal rhythm and 12 people are atrial fibrillation. 5 people need heart pacemakers for a short time. All the people don’t need heart pacemakers. The cardiac perforation has nothing to do with the people. The result of the follow-up is that 94 people are sinus rhythm and 3 people are atrial flutter and 7 people are atrial fibrillation and 11 people are dead. The cause of the death is unknown. The cure rate of atrial fibrillation is 90.38%(94/104).Conclusions: The radiofrequency ablation modified maze operation is a simple method with little trauma and good therapeutic effect. The cure rate of atrial fibrillation is high. Do the radiofrequency ablation modified maze operation while other heart operations is going on is an effective and safe technique for treating in patients. The method could improve patients’ heart function and patients’ life quality. The patients’ sinus converting rate is high. The heart rate of atrial fibrillation and the size of the left atrium influence the restoration and maintenance of sinus rhythm after operation. They are the main reason. The multicenter, large data cases and long-term follow-up(older than 10 years) are needed to confirm the clinical therapeutic effect of the radiofrequency modified maze procedure combined with open-heart surgery and the multiple factors influencing the sinus converting rate of radiofrequency ablation operation. |
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