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Vol. 23, Art. 8 (pp. 136-146)    |    2022       

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Long-term results of surgical treatment of paroxysmal form of atrial fibrillation with left atrial radiofrequency ablation in patients during mitral valve replacement in settings of extracorporeal circulation.

Sungatullin M. A., Abdulyanov I. V., Vagizov I. I., Khairullin R.N.

Interregional Clinic and Diagnostic Center (ICDC)
Kazan State Medical Academy

Brief summary

The aim of the study was to assess the results of surgical treatment of paroxysmal form of atrial fibrillation (AF), with a refined method of radiofrequency ablation (left atrial RFA) in patients during mitral valve replacement. Clinical effect of treatment was assessed in a long-term follow-up. Materials and Methods: The randomized single center study was conducted in ICDC in Kazan city. 43 patients, who underwent surgery in the period from 2011 to 2018, were recruited in the study. Individuals of female gender were prevalent - 29 (67.4%). The mean age of patients equaled to 58?7 years. All patients had combined pathology of mitral valve, which required the valve replacement with a prosthetic device and paroxysmal form of AF in medical history (the duration of AF paroxysms was 19 ? 4 months). According to NYHA classification 30 patients corresponded to II Functional Class (FC) - 69% and 13 patients corresponded to II FC -31%, respectively. Risk was 1.9?0.6%. according to EuroScore II All patients underwent mitral valve replacement, with Medinzh -2 (registered trademark) - 32 patients, biological prosthesis -11 patients. Before the stage of mitral valve replacement, patients underwent surgical ablation of pulmonary vein ostia and left atrium with radiofrequency energy on a dry heart, using the approach of manifold application on one line in order to achieve the best intramural damage, exercising control over the application of radio-frequency energy on the monitor of the generator. The follow-up period was 22?7 months. The differences of measurements were considered statistically significant at p<0.05. Results and discussion: In the analysis of early post-surgical results sinus rhythm restoration and retention was observed in 42 patients (97.6%). In the early post-surgical period, 10- days mortality amounted to 1 case, the reason of mortality was acute left ventricular failure, not related to RFA treatment. In 3(6.97%) cases atrioventricular blockade developed in the early post-surgical period, which was reversed, with sinus rhythm restoration during 3-5 days after the operative interventions (patients were on temporary cardiac stimulation in AAI mode). After 22?7 months completeness of follow-up composed 95% (41 patients). There was 1 fatal outcome after 13 months from surgery (the reason was acute cerebrovascular event). Sinus rhythm was registered in 40 studied patients, i.e. 93%. 37 patients were classified as I FC- 92.5%. Conclusions: Surgical treatment of paroxysmal form of atrial fibrillation with the method of radiofrequency ablation of pulmonary veins and left atrium during mitral valve replacement permits to restore a sinus rhythm and retain it in the long-term follow-up.


Key words

surgical treatment of atrial fibrillation, left atrial radiofrequency ablation, mitral valve replacement, paroxysmal form of atrial fibrillation, long-term results.

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