Abstract:

Objective To investigate the outcomes of radiofrequency ablation modified maze procedure during open-heart surgery for patients with atrial fibrillation, and analyse the factors influencing the efficacy. Methods One hundred and sixty-one patients with atrial fibrillation undergoing cardiovascular surgery were treated on the basis of modified Cox's Maze Ⅲ. Twenty-seven patients with mild tricuspid valve disease were treated with simple left atrial ablation (single room ablation group), and 134 patients with moderate to severe tricuspid valve disease underwent double room ablation (double room ablation group). The success rate of ablation, postoperative complications, and impact factors for postoperative recovery of sinus rhythm were analysed in two groups. Results All patients were followed up for an average of (24.64±12.92) months after surgery. Electrocardiographic monitoring indicated that sinus rhythm was recovered in 69.57% of patients immediately after surgery, and 14.91% of patients had nodal rhythm. The percentages of patients with sinus rhythm were 75.78% and 81.37% at discharge and 6 months after operation respectively. The recovery rate of sinus rhythm in single room ablation group was 77.78%, and that in double room ablation group was 82.09%, and there was no significant difference between two groups (P>0.05). Multivariate analysis revealed that cardiac function classification, ejection fraction after surgery, time of cardiopulmonary bypass and time of aortic cross-clamping were main factors affecting recovery of sinus rhythm (P<0.05). Conclusion Atrial fibrillation with mild tricuspid valve disease should be treated with simple left atrial ablation, atrial fibrillation with moderate to severe tricuspid valve disease should be managed with double atrial ablation, and both may yield similar outcomes. Cardiac function classification before surgery, ejection fraction after surgery, time of cardiopulmonary bypass and time of aortic cross-clamping are the main predictors for recovery of sinus rhythm after ablation.

Key words: radiofrequency ablation, atrial fibrillation, modified maze procedure