Cao Hailong, Xue Yunxing, Zhou Qing, Yu Minggang, Tang Chenbin, Wang Dongjin
Department of Thoracic and Cardiovascular Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan RD, Nanjing, 210008, China.
J Cardiothorac Surg. 2017 Aug 3;12(1):63. doi: 10.1186/s13019-017-0627-z.
Atrial fibrillation (AF) adversely affects surgical outcomes of cardiac valve surgery. Surgical ablation is an effective way to treat valvular AF. The aim of this study was to evaluate the late outcome of surgical radiofrequency ablation and explore the risk factors of AF recurrence in Chinese patients undergoing cardiac valve surgery.
Three hundred ninety six consecutive patients with persistent valvular AF were enrolled in this study. They underwent concomitant modified Maze IV and were completed follow-ups. Cox survival regression model was used to screen independent risk factors for predicting late recurrence of AF.
During the follow-up period of 28 (6 ~ 61) months, AF recurred in 151 patients (38.1%). In multivariate survival regression, factors predictive of AF late recurrence were AF duration, pre-operative serum B-type natriuretic peptide (BNP), pre-operative heart rate and left atrial diameter (LAD), post-operative atrial tachyarrhythmias and AF at discharge. According to receiver operating characteristic curve analysis, the best cutoff values for AF duration, BNP, heart rate and LAD were 66.5 months, 251 pg/ml, 82 beats/min and 67.9 mm, respectively.
Longer AF duration, larger LAD, higher BNP level and lower heart rate indicated a poor late outcome of surgical radiofrequency ablation in persistent AF patients undergoing cardiac valve surgery. Therefore, indication to radiofrequency ablation should be carefully considered in these patients.
心房颤动（AF）会对心脏瓣膜手术的外科手术结果产生不利影响。外科消融是治疗瓣膜性AF的有效方法。本研究的目的是评估外科射频消融的远期结果，并探讨接受心脏瓣膜手术的中国患者AF复发的危险因素。
本研究纳入了396例连续的持续性瓣膜性AF患者。他们接受了改良迷宫IV手术并完成了随访。采用Cox生存回归模型筛选预测AF远期复发的独立危险因素。
在28（6~61）个月的随访期内，151例患者（38.1%）出现AF复发。在多因素生存回归分析中，预测AF远期复发的因素包括AF持续时间、术前血清B型利钠肽（BNP）、术前心率和左心房直径（LAD）、术后房性快速心律失常以及出院时的AF。根据受试者工作特征曲线分析，AF持续时间、BNP、心率和LAD的最佳截断值分别为66.5个月、251 pg/ml、82次/分钟和67.9 mm。
对于接受心脏瓣膜手术的持续性AF患者，AF持续时间较长、LAD较大、BNP水平较高和心率较低表明外科射频消融的远期结果较差。因此，对于这些患者应仔细考虑射频消融的适应证。
