Ezelsoy Mehmet, Oral Kerem, Çaynak Barış, Saraçoğlu Kemal Tolga, Saraçoğlu Ayten, Bayramoğlu Zehra, Akpınar Belhhan
Department of Cardiovascular Surgery, Demiroğlu Bilim University Medical School, Istanbul, Turkey.
Department of Cardiovascular Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Apr 24;27(2):152-158. doi: 10.5606/tgkdc.dergisi.2019.17105. eCollection 2019 Apr.
In this study, we aimed to evaluate the long-term outcomes of monopolar or bipolar radiofrequency ablation concomitant to mitral valve surgery in patients with atrial fibrillation.
We retrospectively evaluated a total of 167 patients (67 males, 100 females; mean age 56.8±6.9 years; range, 48 to 65 years) with atrial fibrillation who underwent monopolar or bipolar radiofrequency ablation concomitant to mitral valve surgery between September 2001 and January 2015. The patients were divided into two groups according to the procedure applied as those undergoing monopolar ablation (group 1, n=68) and those undergoing bipolar ablation (group 2, n=99). All patients were followed by electrocardiogram and 24-h Holter monitoring. Echocardiography was performed before discharge, at three and 12 months postoperatively, and annually thereafter. Left atrial volume index, left atrial diameter, and left ventricular ejection fraction were recorded.
There was no significant correlation between the procedure applied and hypertension, hyperlipidemia, diabetes mellitus, chronic obstructive pulmonary disease, history of the cerebrovascular events (p>0.05). The mean preoperative left atrial diameter decreased from 5.3±0.5 cm to 4.9±0.5 cm postoperatively in all patients (p=0.0001). The mean preoperative left atrial volume index decreased from 53.8±0.4 mL/m2 t o 43.7±6.2 m L/m2 i n t he postoperative period (p=0.0001). During follow-up, 61.8% (n=42) of the patients in group 1 and 62.6% (n=62) of the patients in group 2 remained in sinus rhythm. One patient (1.5%) in group 1 and two patients (2.0%) in group 2 developed early postoperative cerebrovascular accident.
Monopolar and bipolar ablation methods are safe and effective methods to ensure long-term sinus rhythm. Both procedures do not increase the morbidity risk with very low thromboembolic complication rates.
在本研究中，我们旨在评估房颤患者在二尖瓣手术同时进行单极或双极射频消融的长期疗效。
我们回顾性评估了2001年9月至2015年1月期间167例接受二尖瓣手术同时进行单极或双极射频消融的房颤患者（67例男性，100例女性；平均年龄56.8±6.9岁；范围48至65岁）。根据所采用的手术方式，将患者分为两组，即接受单极消融的患者（第1组，n = 68）和接受双极消融的患者（第2组，n = 99）。所有患者均接受心电图和24小时动态心电图监测。出院前、术后3个月和12个月以及此后每年进行超声心动图检查。记录左心房容积指数、左心房直径和左心室射血分数。
所采用的手术方式与高血压、高脂血症、糖尿病、慢性阻塞性肺疾病、脑血管事件史之间无显著相关性（p>0.05）。所有患者术前左心房平均直径从5.3±0.5 cm降至术后的4.9±0.5 cm（p = 0.0001）。术前左心房平均容积指数从53.8±0.4 mL/m²降至术后的43.7±6.2 mL/m²（p = 0.0001）。随访期间，第1组61.8%（n = 42）的患者和第2组62.6%（n = 62）的患者维持窦性心律。第1组有1例患者（1.5%）和第2组有2例患者（2.0%）发生术后早期脑血管意外。
单极和双极消融方法是确保长期窦性心律的安全有效方法。两种手术均不会增加发病率风险，血栓栓塞并发症发生率极低。
