Evaluation Of Safety And Efficacy Of Cardiac Valve Replacement With Modified Bipolar Radiofrequency Ablation For Atrial Fibrillation

Objective The treatment of atrial fibrillation is now primarily based on cardiology,mainly including drug therapy,electrical conversion and catheter radiofrequency ablation.For patients with cardiac valvular disease complicated with atrial fibrillation,whether surgery with cardiac valve replacement can simultaneously treat atrial fibrillation is currently a hot issue in clinical studies.In this paper,the clinical data of150 patients treated at Anhui Provincial Hospital are analyzed and compared to evaluate safety and efficacy of cardiac valve replacement with modified bipolar radiofrequency ablation for atrial fibrillation,to further study the factors affecting atrial fibrillation recurrence after the surgery,and thus to provide theoretical and empirical support for future clinical applications.Methods 110 patients underwent cardiac valve replacement in the department of cardiovascular surgery of Anhui Provincial Hospital from January to June in 2018 are selected as the surgical group,and 60 patients who underwent cardiac valve replacement with modified bipolar radiofrequency ablation for atrial fibrillation as the ablation group and 50 patients who underwent merely cardiac valve replacement as the control group.Meanwhile,40 patients who were treated with catheter radiofrequency ablation in the department of cardiology of the hospital during the same period are studied as the cardiology group.All patients in the surgical group received auxiliary examinations such as electrocardiogram(ECG),orthotopic chest radiograph,and cardiac ultrasonography before surgery.Operation is based on clear diagnosis and surgicalindications,and exclusion of surgical contraindications.Postoperative monitoring of ECG,blood pressure and oxygen saturation,anti-infection,anti-coagulation,cardiac strengthening,diuresis,fluid rehydration and other symptomatic treatment were performed,and ECG were re-examined on the day of surgery,at discharge,1 month after surgery,2 months after surgery,and 3 months after surgery respectively.Preoperative general information,operative indicators,postoperative mortality and complications,and sinus rhythm recovery were recorded.In the cardiology group,all patients received catheter radiofrequency ablation after auxiliary examinations as ECG,orthotopic chest radiograph,and exclusion of surgical contraindications.Postoperative monitoring of ECG,blood pressure and oxygen saturation,anti-coagulation,anti arrhythmia and other symptomatic treatment were performed,and ECG were re-examined on the day of surgery and at discharge respectively.recorded in patients with preoperative general information and sinus rhythm after recovery.Preoperative general information and postoperative sinus rhythm recovery were recorded.Results Almost all patients are operated successfully,except one died after operation,the rest are discharged uneventfully.On the one hand,the variations between the ablation group and the control group have no statistical significance in duration of aortic occlusion(93.93±30.06 vs 88.06±35.11min),postoperative monitoring(1.97±0.96 vs 1.80±0.83d),postoperative hospitalization(11.83±5.50 vs 11.08±4.48d)and postoperative mortality and complications(P>0.05).But they are statistically meaningful that the prolonged length of cardiopulmonary bypass(164.58±43.92 vs139.10±38.67min)and operation(300.03±53.43 vs 276.24±54.02min)and the recovery rate of sinus rhythm is found to increase significantly in the ablation group(P<0.05).On the other hand,the variations between the ablation group and the cardiology group have no statistical meaning in sinus rhythm recovery rate on the dayof surgery and at discharge.For patients whose preoperative left atrial diameter≥60mm in the ablation group,the postoperative recurrence rate of atrial fibrillation is higher than those whose left atrial diameter <60mm before surgery,and the difference is statistically significant(P<0.05)while it has no statistical significance in age,cardiac function grade,left ventricular ejection fraction and type of valve lesion(P>0.05).Conclusion For patients with cardiac valvular disease complicated with preoperative atrial fibrillation,the operation of valve replacement with modified bipolar radiofrequency ablation for atrial fibrillation will not significantly increase the risk of operation.It is safe and reliable and its therapeutic effect is no worse than that of catheter radiofrequency ablation.Besides,the recovery rate of sinus rhythm is significantly improved and maintained according to short-term clinical follow-up.Through study,the factors affecting recurrence after radiofrequency ablation for atrial fibrillation may be related to preoperative left atrial diameter,not to age,preoperative cardiac function grade left ventricular ejection fraction or type of valve lesion.