Download PDF
Thorac Cardiovasc Surg 2015; 63(03): 250-256
DOI: 10.1055/s-0034-1396932
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

The Midterm Results of Radiofrequency Ablation and Vagal Denervation in the Surgical Treatment of Long-Standing Atrial Fibrillation Associated with Rheumatic Heart Disease

Zongtao Yin
1   Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
,
Huishan Wang
1   Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
,
Zengwei Wang
1   Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
,
Jinsong Han
1   Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
,
Yong Zhang
1   Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
,
Hongguang Han
1   Department of Cardiovascular Surgery, Shenyang Northern Hospital, Shenyang, China
› Author Affiliations
Further Information

Publication History

21 September 2014

11 November 2014

Publication Date:
05 March 2015 (online)

    Permissions and Reprints All articles of this category

Abstract

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).

Conclusion 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.

Keywords

atrial fibrillation - radiofrequency - vagal denervation - rheumatic heart disease
 

  • References

  • 1 Cox JL, Schuessler RB, Lappas DG, Boineau JP. An 8 1/2-year clinical experience with surgery for atrial fibrillation. Ann Surg 1996; 224 (3) 267-273 , discussion 273–275
    CrossrefPubMedGoogle Scholar
  • 2 Damiano Jr RJ, Schwartz FH, Bailey MS , et al. The Cox maze IV procedure: predictors of late recurrence. J Thorac Cardiovasc Surg 2011; 141 (1) 113-121
    CrossrefPubMedGoogle Scholar
  • 3 Sakamoto S, Schuessler RB, Lee AM, Aziz A, Lall SC, Damiano Jr RJ. Vagal denervation and reinnervation after ablation of ganglionated plexi. J Thorac Cardiovasc Surg 2010; 139 (2) 444-452
    CrossrefPubMedGoogle Scholar
  • 4 European Heart Rhythm Association (EHRA); European Cardiac Arrhythmia Scoiety (ECAS); American College of Cardiology (ACC); American Heart Association (AHA); Society of Thoracic Surgeons (STS), Calkins H, Brugada J, Packer DL. , et al; HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2007; 4 (6) 816-861
    CrossrefPubMedGoogle Scholar
  • 5 Nitta T, Ishii Y, Ogasawara H , et al. Initial experience with the radial incision approach for atrial fibrillation. Ann Thorac Surg 1999; 68 (3) 805-810 , discussion 811
    CrossrefPubMedGoogle Scholar
  • 6 Pauza DH, Skripka V, Pauziene N, Stropus R. Morphology, distribution, and variability of the epicardiac neural ganglionated subplexuses in the human heart. Anat Rec 2000; 259 (4) 353-382
    CrossrefPubMedGoogle Scholar
  • 7 Society of Cardiology, Chinese Medical Association. Retrospective investigation of hospitalized patients with atrial fibrillation in mainland China. Chin Med J (Engl) 2004; 117 (12) 1763-1767
    PubMedGoogle Scholar
  • 8 Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998; 98 (10) 946-952
    CrossrefPubMedGoogle Scholar
  • 9 Gillinov AM. Advances in surgical treatment of atrial fibrillation. Stroke 2007; 38 (2, Suppl): 618-623
    CrossrefPubMedGoogle Scholar
  • 10 Abreu Filho CA, Lisboa LA, Dallan LA , et al. Effectiveness of the maze procedure using cooled-tip radiofrequency ablation in patients with permanent atrial fibrillation and rheumatic mitral valve disease. Circulation 2005; 112 (9, Suppl): I20-I25
    PubMedGoogle Scholar
  • 11 Kosakai Y, Kawaguchi AT, Isobe F , et al. Cox maze procedure for chronic atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg 1994; 108 (6) 1049-1054 , discussion 1054–1055
    PubMedGoogle Scholar
  • 12 Voeller RK, Bailey MS, Zierer A , et al. Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze Procedure. J Thorac Cardiovasc Surg 2008; 135 (4) 870-877
    CrossrefPubMedGoogle Scholar
  • 13 Gaynor SL, Schuessler RB, Bailey MS , et al. Surgical treatment of atrial fibrillation: predictors of late recurrence. J Thorac Cardiovasc Surg 2005; 129 (1) 104-111
    CrossrefPubMedGoogle Scholar
  • 14 Gillinov AM, Sirak J, Blackstone EH , et al. The Cox-maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation. J Thorac Cardiovasc Surg 2005; 130 (6) 1653-1660
    CrossrefPubMedGoogle Scholar
  • 15 Melo J, Santiago T, Aguiar C , et al. Surgery for atrial fibrillation in patients with mitral valve disease: results at five years from the International Registry of Atrial Fibrillation Surgery. J Thorac Cardiovasc Surg 2008; 135 (4) 863-869
    CrossrefPubMedGoogle Scholar
  • 16 Stulak JM, Sundt III TM, Dearani JA, Daly RC, Orsulak TA, Schaff HV. Ten-year experience with the Cox-maze procedure for atrial fibrillation: how do we define success?. Ann Thorac Surg 2007; 83 (4) 1319-1324
    CrossrefPubMedGoogle Scholar
  • 17 Zipes DP, Mihalick MJ, Robbins GT. Effects of selective vagal and stellate ganglion stimulation of atrial refractoriness. Cardiovasc Res 1974; 8 (5) 647-655
    CrossrefPubMedGoogle Scholar
  • 18 Po SS, Nakagawa H, Jackman WM. Localization of left atrial ganglionated plexi in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2009; 20 (10) 1186-1189
    CrossrefPubMedGoogle Scholar
  • 19 Oh S, Zhang Y, Bibevski S, Marrouche NF, Natale A, Mazgalev TN. Vagal denervation and atrial fibrillation inducibility: epicardial fat pad ablation does not have long-term effects. Heart Rhythm 2006; 3 (6) 701-708
    CrossrefPubMedGoogle Scholar
  • 20 Calò L, Rebecchi M, Sciarra L , et al. Catheter ablation of right atrial ganglionated plexi in patients with vagal paroxysmal atrial fibrillation. Circ Arrhythm Electrophysiol 2012; 5 (1) 22-31
    CrossrefPubMedGoogle Scholar