The midterm results of radiofrequency ablation and vagal denervation in the surgical treatment of long-standing atrial fibrillation associated with rheumatic heart disease.
BACKGROUND
Though maze III procedure is an effective surgical treatment for atrial fibrillation (AF), the complexity and complications prevent its widespread application. Radiofrequency ablation (RA) has become an accepted therapy, but its chronic effects are still unclear. This retrospective clinical study describes our experience of RA and vagal denervation (VD) in surgical treatment of long-standing AF associated with rheumatic heart disease (RHD) during a 5-year follow-up.


METHODS
Between June 2006 and December 2007, a total of 173 consecutive patients with long-standing AF-associated RHD underwent mitral valve replacement and ablation maze procedure. In total, 92 cases had RA alone and 81 had RA + VD. Patients were followed up with clinical examination and electrocardiography, and the data were analyzed by multivariable analysis with Cox hazard model.


RESULTS
The average follow-up time was 5.0 ± 0.6 years. Multivariable analysis with Cox hazard model revealed that the duration of AF, the size of the left atrium, and tricuspid regurgitation are risk factors for AF recurrence. In addition, long-standing AF ≥ 7 years, left atrium diameter ≥ 58 mm, and severe tricuspid regurgitation may increase the risk of AF recurrence by 2.16-, 2.37-, and 2.67-fold, respectively. Although the freedom from AF during 2 to 5 postoperative years in the RA and RA + VD groups were similar, the percentage of antiarrhythmic drug therapy was higher in the RA group during the early postoperative period (4th month, 54.1 vs. 34.7%, p = 0.017; 5th month, 39.2 vs. 21.3%, p = 0.018; 6th month, 23.0 vs. 10.7%, p = 0.044). Furthermore, the percentage of those free from AF was lower during the 1st year (6th month, 82.2 vs 93.8%, p = 0.023; 1st year, 76.1 vs. 89.9%, p = 0.019).


CONCLUSIONS
RA is effective for the surgical treatment of long-standing AF associated with rheumatic valve disease. Though vagal denervation helped to maintain a stable sinus rhythm at an early stage, there was no additional benefit after the 1st year of follow-up.
Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China.
Zongtao
Z
Yin
Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China.
Huishan
H
Wang
Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China.
Zengwei
Z
Wang
Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China.
Jinsong
J
Han
Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China.
Yong
Y
Zhang
Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China.
Hongguang
H
Han
D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation; D003714:Denervation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000601:surgery*
D000889:Anti-Arrhythmia Agents