Biatrial ablation versus left atrial ablation with bipolar system in the surgical treatment of atrial fibrillation with mitral valve disease

Abstract

Objective The purpose of this study was to compare the outcome after biatrial ablation or left atrial ablation in patients with atrial fibrillation(AF) associated with mitral valve diseases.Methods All 109 patients who received biatrial ablation (n =61) or left atrial ablation (n =48) of atrial fibrillation combined with mitral valve surgery from January 2008 to December 2012 were analyzed for outcome differences.The etiology of mitral valve disease was rheumatic(n =81) and degenerative(n =28).Age at operation ranged from 39 to 62 years.AF duration ranged from 7 months to 13 years.Clinical manifestations of atrial fibrillation were persistent in 34 patiens and long-standing persistent in 75 patients.Results All patients successfully underwent radiofrequency modified maze procedure and mitral valve surgery.The biatrial ablation group had longer cardiopulmonary bypass time and crossclamp time.But there was no significant difference in mechanical ventilation,hospital length of stay and major postoperative complications or other postoperative outcome variables between biatrial ablation and lefi atrial ablation groups.There was 1 early death in left arial ablation group.At postoperative moment,the elimination rate of atrial fibril lation were 100％ (sinus rhythm in 94 and junctional rhythm in 15).At discharge,maintenance of normal sinus rhythm was 93.4％ in biatrial group and 80.9％ in left atrial group (P =0.046).Cumulative maintenance of normal sinus rhythm without atrial fibrillation recurrence at 3 years postoperatively was (89.0 ± 4.4) ％ in biatrial group and (75.6 ± 7.3) ％ in left atrial group,P =0.096.But the incidence of atrial flutter at 1 year postoperatively in left atrial group(10.6％) was significantly higher than the biatrial group (0),P =0.032.Conclusion Compared with left atrial ablation,biatrial ablation was more effective in restoration and maintenance of sinus rhythm without increasing the risk of postoperative complications.In addition,biatrial ablation was more effective in preventing the occurrence of postoperative atrial flutter. Key words: Atrial fibrillation ; Mitral valve ; Catheter ablation