The Relationship Between The Efficacy Of Mitral Valve Mechanical Valve Replacement With Radiofrequency Ablation And Left Atrial Remodeling

Objective:Effect of Left atrial remodeling and mitral valve replacement with bipolar radiofrequency ablation relationship was analysised by zhe literature.The clinical efficacy of mitral valve replacement combined with bipolar radiofrequency ablation in the treatment of atrial fibrillation,as well as the multiple factors of sinus recurrence rate in the near and medium term after surgery were analyzed.Methods:The clinical data of 106 patients with mechanical mitral valve replacement during radiofrequency ablation from January 2014 to February 2017 were analyzed.Patients were diagnosed with rheumatic mitral valve disease combined with atrial fibrillation through chest wall echocardiography and electrocardiogram before surgery.Postoperative cardiac color ultrasound and electrocardiogram were compared.This is a follow-up to a patient who's been discharged from the hospital,three months after hospital discharge,and a year after the hospital discharge?This report uses SPSS 23.0 for data analysis.The measurement data are expressed as mean plus or minus standard deviation.Repeated measurement data were analyzed using repeated measurement variance.Simple effect analysis was used to compare the two after the event.The study of risk factors was conducted with binary Logistic regression,and a=0.05 were taken as the statistical basis.Results:1.In 106 cases of mitral valve mechanical valve replacement with radiofrequency ablation,87 cases is sinus heart rate when patients was the discharged from hospital.Patients of sinus rhythm was at a rate of 82.08%.In the process of follow-up of 3 months to 12 months after discharge,the effective number of follow-up is 103 cases.3 cases was lost to follow-up.There were 82 patients with sinus electrocardiogram(ECG)in the follow-up process,21 cases was atrial fibrillation,and 79.61%with sinus was maintained.The symptoms improved significantly.ECG showed that the left atrial inner diameter(LAD)was significantly smaller than that before surgery.When discharged patients can be divided into sinus rhythm group(87 cases)and the rhythm of the atrial fibrillation group(19 cases).Compared preoperative left atrium diameter of two groups,It had significantly statistical difference(p<0.05).In addition,the two groups were divided into the left atrial diameter>60mm group(30 cases)and the left atrial diameter<60mm group(57 cases)according to the standard of left atrial diameter.The postoperative rate of sinus rhythm has significant statistical difference(p<0.05).Similarly,follow-up of patients can be divided into sinus rhythm group(82 cases)and atrial fibrillation group(21 cases).Compared preoperative left atrium diameter of two groups,It had significantly statistical difference(p<0.05).In addition,the two groups were divided into the left atrial diameter>60mm group(27 cases)and the left atrial diameter<60mm group(55 cases)according to the standard of left atrial diameter.There was a statistically significant difference in sinus rhythm rate between the two groups(p<0.05).The preoperative left atrial diameter was the predictive factor of mid-term efficacy(OR 25.553,CI[1.617-403.693],p = 0.021)..2.The patients when was discharged were divided into to sinus rhythm age group(87 cases)and atrial fibrillation age group(19 cases),There was significant statistical difference(p<0.05)compared the two groups.so to 55 standard boundary,The discharged patients was divided into>55 years old group(36 cases)and<55 years old group(51 cases),two groups of sinus rhythm rate had significantly statistical difference(P<0.05).Similarly,follow-up of patients can be divided into sinus rhythm(82 cases)group and atrial fibrillation group(21 cases),There was significant statistical difference(p<0.05)compared two groups.And put in the two groups on the basis of 55,divided into more than 55 years old group(33 cases)and less than 55 years old group(49 cases),the rate of sinus rhythm had significant statistical difference(p<0.05)compared two groups.Age is a predictive factor for the mid-term efficacy(OR 4.783,CI[1.044-21.925],p = 0.044).3.The difference between the preoperative left atrium and the postoperative left atrium is the influencing factor for the recurrence of atrial fibrillation,it is also the protective factor for the maintenance of sinus rhythm.The probability of atrial fibrillation decreased by 0.862 times with the increase of 1 unit in difference between the preoperative left atrium and the postoperative left atrium.4.At the time of discharge,the patients were divided into three groups:level ? group,level ? groupand level IV group:There was significant statistical difference(p<0.05)between group ? and group IV,group ? and group IV.With EF of 50%value was bounded,the patients was divided into the group of EF values of more than 50%(81 cases)and the group of the EF values is less than 50%group(6 cases),The sinus rhythm rate was 89.0%in groups with EF value over 50%and The sinus rhythm rate was 40.0%in groups with EF value less than 50%.There was the more significant statistical difference(p<0.05)in two groups.5.According to whether the doctor's advice after discharge from the oral amiodarone is divided into two groups,the rate of sinus rhythm in after discharge oral amiodarone group(46 cases)was 95.80%and the rate of sinus rhythm in not taking group(36 cases)after discharge ws 65.50%.There was a significant statistical difference(p<0.05)between the two groups.6.Conclusion:1.The sinus converting rate and maintain the rate of mitral valve replacement with radiofrequency ablation is high.The surgery of mitral valve replacement with radiofrequency ablation is safe and effective.It can improve heart function and the patients quality of life,It is best choice of the treatment of mitral valve combined with atrial fibrillation.2.Left atrial diameter size is risk factors of sinus after converting rate and maintain the rate.Left atrial diameter is the long-term curative effect of preoperative predictors.If the left atrial diameter is more than 60 mm,the sinus maintain rate and sinus after converting rate is low.With the greater of the left atrial diameter,the surgical curative effect is poorer.Left atrial diameter will be significantly reduced after a successful operation.3.Left atrial remodeling is a risk factor for postoperative recurrence of atrial fibrillation,and left atrial reverse remodeling is the protection of the prevention of postoperative recurrence of atrial fibrillation.If the degree of preoperative left atrial remodeling is lower,the left atrial remodeling reversibility is higher and the effect of left atrial reverse remodeling is better.so the recurrence rate of atrial fibrillation after surgery becomes lower and the maintenance rate of sinus rhythm after surgery the higher.The surgical effect becomes more effective.4.The patient age is risk factors of sinus after converting rate and maintain the rate.It is the long-term curative effect of predicting factors.The patients less than 55 years old have high postoperative sinus successful rate and maintain sinus rate,and the patients older than 55 years have low postoperative sinus successful rate and maintain sinus rate.The older the patients are,the less effective the surgery is.5.Preoperative heart function is risk factors of sinus after converting rate and maintain the rate.The sinus after converting rate and sinus maintain rate of cardiac function class II and class III is high,and the sinus successful rate and maintain sinus of EF values more than 50%is high.On the contrary,the sinus recurrence rate and sinus maintenance rate were low in patients with grade ? cardiac function and less than 50%EF.The cardiac function would be significantly improved after successful surgery.6.The route,scope and degree of radiofrequency ablation are strictly accurate,and the operation is the key to ensure the efficacy of postoperative sinus transfer.Postoperative enhancement of cardiac function therapy and combined drug rehabilitation is an important therapeutic link in the maintenance of sinus rhythm.The multivariate factors that affect the radiofrequency ablation sinus transition rate need to be confirmed by multiple centers,large sample cases and long-term follow-up observation.