| Background And ObjectiveSurgical treatment of atrial fibrillation is an conventional and effctive method for treatment of atrial fibrillation, COX maze Ⅲ type surgery is a classic surgical surgical treatment of atrial fibrillation. But COX maze Ⅲ type surgery was not widely apply to clinical because of its complex surgical procedures, a series of atrial incision, large surgical trauma, bleeding problems, postoperative complications and also increasing surgical risk. As a representative surgical approach of the radiofrequency ablationn.Cardioblate M Pen can achieve lasting stability heat, reduce loss of heat due to heat conduction, help to get transmural ablationn lines. High-frequency electric knife is our own research and patent, it has the same mechanism compared to Cardioblate TM Pen:heat denaturation, atrial coagulation necrosis, the formation of hard scar, cell necrosis within the lesion, blocking the electrical activity, pulmonary vein isolation. In this study, based on clinical, we choosed patients who suffered from rheumatic heart disease with atrial fibrillation and scheduled for valve replacement and atrial fibrillation ablation in our hospital between August 2012 to December 2014. To find the difference of this two procedures in patients with valve surgery and atrial fibrillation ablation for the same period.patients were randomly divided into Cardioblate TM Pen ablation group(group C) and high-frequency electric knife ablation group(group H). Perioperative datas were collected and analyzed.Methodswe choosed patients who suffered from rheumatic heart disease with atrial fibrillation and scheduled for valve replacement and atrial fibrillation ablation in our hospital between August 2012 to March 2015. Cardioblate TM Pen (group C) using Cardioblate TM Pen (Medtronic company), the power is 25～30 J, cold saline at 60 drops/min. We used valleylab force Ⅱ system and High-frequency electric knife in coagulation mode (80～100w). Modified Cox Mazelllsurgical procedures are list as followed:(1) epicardial ablation:after CPB was established, epicardial ablation around the pulmonary veins and Marshall ligament ablation or cutting. (2) two pulmonary vein ring isolation:0.5～1cm away from the outside of the pulmonary vein ablation,left ablation circle ring extended to the left atrial appendage (LAA ablation site needs to be replaced with a double bend or double bend rotation electrical knife) (3)straight ablation line between pulmonary vein isolation and the top roof of the left atrial, another straight line was needed if the left artrial is realtive large。(4) straight ablation line between the midpoint of mitral annulus and the left pulmonary vein loop (5) atrial septal tangent:up to the top of the left atrium, down to the bottom of the left atrium(6)straight ablation line between the tricuspid and the lower end of atrial septal incision, right of the coronary sinus (7) straight ablation line between the tricuspid and the upper end of the right atrial appendage incision to the tricuspid annulus spacer, this can be carried out under the beating heart (8)right atrial tangent:the right atrial appendage not resect, longitudinal incision on the right atrial appendage to the atrioventricular groove, down to near the inferior vena cava atrioventricular groove (9)left atrial appendage ligation and resection:0.5cm at the base of the left atrial appendage using7 double silk ligature, ablation at the ligation level annuls, clinical parameter including intraoperative cardiac resuscitation, the CPB time, ascending aortic occlusion time, mechanical ventilation time, ICU observing time, complications and so on are recorded.ResultsPreoperative data was no significant difference, the incidence of complications during the postoperative hospital stay was no significant difference between the two groups, mechanical ventilation time, ICU observing time, postoperative hospital stay time was no significant difference. Group H ablation time 6-30min (15.05±5.85), Group C ablation time 11-34min (21.87±6.90), the difference was statistically significant. Into the statistics of 120 cases of patients with no operative mortality, surgical immediate sinus rhythm of 98%, one case of left ventricular rupture(group H), cardiac tamponade one case (ascending aorta incision bleeding), mood room bleeding. Sixteen cases of temporary pacemaker placement of 1 to 5 days, no 3-degree atrioventricular block occurred. Telephone or clinic follow up 1～30 (7.4 ±4.7) months, a total of 11 cases were lost follow up, follow-up rate of 90.8%. Electric knife group success rate of 73.7% cure atrial fibrillation. CardioblateTM Pen success rate of 74.5%. The difference was not statistically significant (X2=0.3670, P =0.5446)ConclusionApplication of high-frequency electric knife can get nearly the same outcome compare to CardioblateTM Pen. Use a 80～100w coagulation power is safe and effctive for atrial ablation. It is innovative to use circle ablation after left atrial appendage ligation, because this procedure can not only preventing thrombosis, but also retains the appendage of endocrine function. The left pulmonary vein ring expand the base of the left atrial appendage, simplify the left pulmonary vein ablation lines to solve the problem that hard to reveal. The operation is relatively simple, with less time, worthy of further clinical application and promotion... |
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