Tratamento cirúrgico de fibrilação atrial utilizando ablação com radiofrequência bipolar em doença mitral reumática

Canale, Leonardo Secchin; Colafranceschi, Alexandre Siciliano; Monteiro, Andrey José de Oliveira; Marques, Bruno Miranda; Canale, Clara Secchin; Koehler, Ernesto Chavez; Filho, Fernando Eugênio dos Santos Cruz

doi:10.5935/1678-9741.20110046

Cited by 11 publications

(5 citation statements)

References 22 publications

(19 reference statements)

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“…The rate of sinus rhythm patients after surgical ablation of AF at hospital discharge of 73% and, 63% during the 1-year follow-up period, is compatible with the current series reported in rheumatic patients [20] .…”

Section: Discussionsupporting

confidence: 89%

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Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

Chavez¹,

Colafranceschi²,

Monteiro³

et al. 2017

Braz J Cardiovasc Surg

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ObjectiveTo assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated.MethodsRetrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated.ResultsAfter one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%.ConclusionAtrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.

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Section: Discussionsupporting

confidence: 89%

“…In this clinical scenario, the impact of the use of bipolar radiofrequency devices in the surgical treatment of atrial fibrillation in operative mortality and in event-free survival is still to be defined [20-22] .…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

Chavez¹,

Colafranceschi²,

Monteiro³

et al. 2017

Braz J Cardiovasc Surg

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“…AF is a common complication of RHD and the risk of it increases along with the severity of mitral valve lesion [ 19 – 20 ]. Previous studies indicated that RHD not only affected the heart valves, but also caused chronic inflammation and platelet activation, leading to fibrosis and muscle fibers in the atria [ 19 ]. Electrophysiological and electroanatomical abnormalities within the left atrium have been detected in these patients, resulting into a more inducibility of AF [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Bipolar Radiofrequency Ablation in Treatment of Atrial Fibrillation Associated with Rheumatic Heart Disease

Zhu

et al. 2016

PLoS ONE

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BackgroundAmong patients with rheumatic heart disease (RHD), 45% to 60% present with atrial fibrillation (AF), which is associated with increased rates of thromboembolism, heart failure, and even death. The bipolar radiofrequency ablation (BRFA) combining with mitral valve procedure has been adopted in patients of AF associated with RHD, but evaluations about its effectiveness are still limited.MethodsA total of 87 patients with RHD and long persistent AF who had accepted mitral valve replacement concomitant with BRFA were studied. Clinical data were collected to analyze the midterm results of BRFA and evaluate its efficiency. Univariate and multivariate analyses were used to identify the independent factors associated with late AF recurrence.ResultsSixty-six (75.9%) patients maintained sinus rhythm after a mean follow-up of 13.4 ± 5.2 months. Late AF recurrence had been detected in 21 (24.1%) patients, 11 (12.6%) patients were confirmed to be AF, 8 (9.2%) patients were atrial flutter and 2 (2.3%) patients were junctional rhythm. In Multivariate logistic regression analysis, body mass index (BMI) (OR = 1.756, 95% CI = 1.289–2.391, p = 0.000) and early AF recurrence (OR = 5.479, 95% CI = 1.189–25.254, p = 0.029) were independent predictors of late AF recurrence. In addition, left ventricular ejection fraction (LVEF) and New York Heart Association class showed a greater improvement in patients who maintained sinus rhythm than those who experienced late AF recurrence.ConclusionBRFA is an effective technique for the treatment of long persistent AF associated with RHD during mitral valve replacement. The BMI and early AF recurrence are independent predictors for late AF recurrence. Patients with long-term restoration of sinus rhythm experienced a greater improvement of left ventricular function after BRFA.

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“…In 2011, Canale et al [ 59 , 60 ] performed retrospective studies demonstrating that the use of bipolar radiofrequency led to the reversal of arrhythmia in 68% of the patients after 14 months in one of the studies and in 73% of the patients in the period of 7 months according to the other one. The author's experience with the use of bipolar radiofrequency was more efficient than with unipolar.…”

Section: Discussionmentioning

confidence: 99%

Surgical Ablation of Atrial Fibrillation Using Energy Sources

Brick

Braile

2015

Revista Brasileira De Cirurgia Cardiovascular

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Surgical ablation, concomitant with other operations, is an option for treatment in patients with chronic atrial fibrillation. The aim of this study is to present a literature review on surgical ablation of atrial fibrillation in patients undergoing cardiac surgery, considering energy sources and return to sinus rhythm. A comprehensive survey was performed in the literature on surgical ablation of atrial fibrillation considering energy sources, sample size, study type, outcome (early and late), and return to sinus rhythm. Analyzing studies with immediate results (n=5), the percentage of return to sinus rhythm ranged from 73% to 96%, while those with long-term results (n=20) (from 12 months on) ranged from 62% to 97.7%. In both of them, there was subsequent clinical improvement of patients who underwent ablation, regardless of the energy source used. Surgical ablation of atrial fibrillation is essential for the treatment of this arrhythmia. With current technology, it may be minimally invasive, making it mandatory to perform a procedure in an attempt to revert to sinus rhythm in patients requiring heart surgery.

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Tratamento cirúrgico de fibrilação atrial utilizando ablação com radiofrequência bipolar em doença mitral reumática

Cited by 11 publications

References 22 publications

Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

Analysis of Bipolar Radiofrequency Ablation in Treatment of Atrial Fibrillation Associated with Rheumatic Heart Disease

Surgical Ablation of Atrial Fibrillation Using Energy Sources

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