Comparison of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Jian , WANG Liming , SHI Sheng ,  YUAN Zhongxiang

Cardiac and Vascular Department, Shanghai First People's Hospital, Shanghai, 200080, P.R.China;

Corresponding author：

YUAN Zhongxiang, Email: yuanzx828@163.com

Keywords：

Rheumatic heart disease; valve replacement; atrial fibrillation; radiofrequency ablation

DOI：

10.7507/1007-4848.201601048

Video：

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Objective To compare the effect of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease. Methods The clinical data of 261 patients who underwent valve replacement and radiofrequency Maze Ⅲ procedure in Shanghai First People's Hospital from 2010 to 2015 were retrospectively analyzed. According to the radiofrequency ablation system, patients were assigned to a monopolar radiofrequency ablation group (n=209, 129 males, 80 females, aged 59.6±9.7 years) and a bipolar radiofrequency ablation group (n=52, 36 males, 16 females, aged 58.6±11.2 years). After procedures, clinical factors such as patients' basic information, perioperative complication and mortality, the elimination rate of atrial fibrillation were measured. Results There was no statistic difference in perioperative morbidity and mortality between two groups. The ablation time of the monopolar radiofrequency ablation group was longer than that of the bipolar group (29.7±3.3 minvs. 22.3±7.8 min,P=0.035). Postoperative diameter of left atrium was reduced in both groups. Compared with the monopolar radiofrequency ablation group, bipolar group had a better elimination rate of atrial fibrillation at three months and one year follow-up (82.0%vs. 66.3%,P=0.037; 80.0%vs. 59.6%,P=0.008). Conclusion Valve replacement combined with radiofrequency Maze Ⅲ procedure is safe and efficient. Compared with monopolar radiofrequency ablation, bipolar radiofrequency ablation has advantage on elimination rate of atrial fibrillation, ablation time and cardiopulmonary bypass time.

Citation： LIU Jian, WANG Liming, SHI Sheng, YUAN Zhongxiang. Comparison of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(3): 217-221. doi: 10.7507/1007-4848.201601048 Copy

1.	Albåge A, Johansson B, Kennebäck G, et al. Long-term follow-up of cardiac rhythm in 320 patients after the Cox-Maze Ⅲ procedure for atrial fibrillation. Ann Thorac Surg, 2016, 101(4): 1443-1449.
2.	Ramlawi B, Abu Saleh WK. Surgical ablation of atrial fibrillation. Methodist Debakey Cardiovasc J, 2015, 11(2): 104-108.
3.	Garcia-Villarreal OA, Fernández-Ceseña E, Vega-Hernández R. Cox maze III procedure: the best alternative in surgery for atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 148(1): 368-369.
4.	Lawrance CP, Henn MC, Damiano RJ. Surgery for atrial fibrillation. Cardiol Clin, 2014, 32(4): 563-571.
5.	Cox JL, Schuessler RB, Lappas DG, et al. An 8 1/2-year clinical experience with surgery for atrial fibrillation. Ann Surg, 1996, 224(3): 267-273.
6.	Bogachev-Prokophiev A, Zheleznev S, Pivkin A, et al. Assessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter? Interact Cardiovasc Thorac Surg, 2014, 18(2): 177-182.
7.	Bogachev-Prokophiev A, Zheleznev S, Romanov A, et al. Ablation for atrial fibrillation during mitral valve surgery: 1-year results through continuous subcutaneous monitoring. Interact Cardiovasc Thorac Surg, 2012, 15(1): 37-41.
8.	Gillinov AM, Gelijns AC, Parides MK, et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med, 2015, 372(15): 1399-1409.
9.	Maltais S, Forcillo J, Bouchard D, et al. Long-term results following concomitant radiofrequency modified maze ablation for atrial fibrillation. J Card Surg, 2010, 25(5): 608-613.
10.	Wong KC, Sadarmin PP, Prendergast BD, et al. Acute occlusion of left circumflex artery following radiofrequency catheter ablation at the mitral isthmus. Europace, 2010,12(5): 743-745.
11.	Deng WN, Chen KE, Bai R, et al. Pouched mitral isthmus is associated with incomplete linear block in atrial fibrillation patients with mechanical mitral valve replacement. J Cardiovasc Electrophysiol, 2015, 26(5): 501-508.
12.	Expósito V, Rodríguez-Entem F, González-Enríquez S. Stroke and systemic embolism after successful ablation of typical atrial flutter. Clin Cardiol, 2016, 39(6): 347-351.
13.	Zhu X, Li Q, Li Y, et al. Analysis of bipolar radiofrequency ablation in treatment of atrial fibrillation associated with rheumatic heart disease. PLoS One, 2016, 11(3): e0151248.
14.	Liu H, Chen L, Xiao Y, et al. Early efficacy analysis of biatrial ablation versus left and simplified right atrial ablation for atrial fibrillation treatment in patients with rheumatic heart disease. Heart Lung Circ, 2015, 24(8): 789-795.

1. Albåge A, Johansson B, Kennebäck G, et al. Long-term follow-up of cardiac rhythm in 320 patients after the Cox-Maze Ⅲ procedure for atrial fibrillation. Ann Thorac Surg, 2016, 101(4): 1443-1449.
2. Ramlawi B, Abu Saleh WK. Surgical ablation of atrial fibrillation. Methodist Debakey Cardiovasc J, 2015, 11(2): 104-108.
3. Garcia-Villarreal OA, Fernández-Ceseña E, Vega-Hernández R. Cox maze III procedure: the best alternative in surgery for atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 148(1): 368-369.
4. Lawrance CP, Henn MC, Damiano RJ. Surgery for atrial fibrillation. Cardiol Clin, 2014, 32(4): 563-571.
5. Cox JL, Schuessler RB, Lappas DG, et al. An 8 1/2-year clinical experience with surgery for atrial fibrillation. Ann Surg, 1996, 224(3): 267-273.
6. Bogachev-Prokophiev A, Zheleznev S, Pivkin A, et al. Assessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter? Interact Cardiovasc Thorac Surg, 2014, 18(2): 177-182.
7. Bogachev-Prokophiev A, Zheleznev S, Romanov A, et al. Ablation for atrial fibrillation during mitral valve surgery: 1-year results through continuous subcutaneous monitoring. Interact Cardiovasc Thorac Surg, 2012, 15(1): 37-41.
8. Gillinov AM, Gelijns AC, Parides MK, et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med, 2015, 372(15): 1399-1409.
9. Maltais S, Forcillo J, Bouchard D, et al. Long-term results following concomitant radiofrequency modified maze ablation for atrial fibrillation. J Card Surg, 2010, 25(5): 608-613.
10. Wong KC, Sadarmin PP, Prendergast BD, et al. Acute occlusion of left circumflex artery following radiofrequency catheter ablation at the mitral isthmus. Europace, 2010,12(5): 743-745.
11. Deng WN, Chen KE, Bai R, et al. Pouched mitral isthmus is associated with incomplete linear block in atrial fibrillation patients with mechanical mitral valve replacement. J Cardiovasc Electrophysiol, 2015, 26(5): 501-508.
12. Expósito V, Rodríguez-Entem F, González-Enríquez S. Stroke and systemic embolism after successful ablation of typical atrial flutter. Clin Cardiol, 2016, 39(6): 347-351.
13. Zhu X, Li Q, Li Y, et al. Analysis of bipolar radiofrequency ablation in treatment of atrial fibrillation associated with rheumatic heart disease. PLoS One, 2016, 11(3): e0151248.
14. Liu H, Chen L, Xiao Y, et al. Early efficacy analysis of biatrial ablation versus left and simplified right atrial ablation for atrial fibrillation treatment in patients with rheumatic heart disease. Heart Lung Circ, 2015, 24(8): 789-795.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease

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