The results of the endovascular ablational electrodes use for the fulfillment of Maze procedure in conditions of heart-lung bypass for the treatment of atrial fibrillation/flutter in patient with atrial septal defect
Purpose of work: to improve the course of late postoperative period due to normalization of cardiac rhythm with radiofrequency ablation (RFA) wich is performed according original method in patients with atrial septal defect and AF/AFL during surgical correction of defects.
We have studied 73 patients with ASD with concomitant AF/AFL, including 31 (42,5%) men and 42 (57,5%) women, whose average age was 37,2±14. Diagnoses were made by data of ECHO-KG, ECG and Holter monitoring. In all 73 patients ASD was surgically corrected and RFA (procedure “MAZE”) was performed. In comparison group we included 27 patients with ASD complicated with AF/AFL, including 13 (48%) men and 14 (52%) women, average age was 39,4±16 years, who underwent plastic surgery of ASD. Long-term results studied in 69 patients in the study group and 27 patients of control group. Heart rate variability was evaluated at discharge, after 12 and 24 months after surgery by Holter-ECG data.
The maintenance of sinus rhythm (SR) at discharge was observed in 65 (89%) patients in the control group and 25 (92%) patients in the comparison group, due to perform direct current cardioversion open heart during surgery. Patients of the main group in the early postoperative period were characterized by lower average values. Results of study of the impact of RFA on preservation of sinus rhythm at 12 and 60 months after surgery showed: in the control group of patients SR was preserved in 83,3% and 63%, respectively. In the study group SR was observed in 7,4% after 12 and 24 months after surgery and subsequent comparison with the control group were not held due to the obvious negative result.
RFA (procedure “MAZE”) is an effective complement for ASD plastic surgery complicated with AF/AFL. Correction of ASD complicated with AF/AFL, without performing “maze” does not lead to regression of arrhythmia in the remote observational period in 92% of cases. Modification of use of endovascular ablation electrodes while performing “MAZE”-procedure, additionally to correction of ASD provides a more sustainable treatment of the initial arrhythmia in a remote postoperative period after 12, 24, 36, 48 and 60 months of follow-up in 83,3; 81,6; 76,7; 76,7 and 63,0% cases respectively. The proposed technology is effective in the treatment of AF/AFL patients with ASD and can be recommended for use in this group of patients.
2. Ninet J., Roques X., Seitelberger R. et al. Surgical ablation of atrial fibrillation with off-pump, epicardial, high-intensity focused ultrasound: results of a multicenter trial // J. Thorac. Cardiovasc. Surg. – Sep 2005. – Vol. 130 (3). – P. 803–809.
3. Nardi P., Mve Mvondo C., Scafuri A. et al. Left atrial radiofrequency ablation associated with valve surgery: midterm outcomes // Thorac. Cardiovasc. Surg. – 2013. – Vol. 61. – P. 392–397
4. Lall S. C., Melby S. J., Voeller R. K. et al. The effect of ablation technology on surgical outcomes after the Cox-maze procedure: a propensity analysis // J. Thorac. Cardiovasc. Surg. – Feb 2007. – Vol. 133 (2). – P. 389–396.
5. Narayan S. M., Krummen D. E., Shivkumar K. et al. Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation) trial // J. Am. Coll. Cardiol. – 2012. – Vol. 60 (7). – P. 628–36.
6. Lee R., McCarthy P. M., Wang E. C. et al. Midterm survival in patients treated for atrial fibrillation: a propensity-matched comparison to patients without a history of atrial fibrillation // J. Thorac. Cardiovasc. Surg. – 2012. – Vol. 143. – P. 1341–1351; discussion 1350–1.
7. Krummen D. E., Narayan S. M. Ablating persistent atrial fibrillation successfully // Curr. Cardiol. Rep. – 2012. – Vol. 14. – P. 563–570.