Abstract
Aim. The aim of this study is to evaluate the efficiency of intraoperative endocardial Radiofrequency Ablation (RFA) treatment at short and mid-term in patients with mitral valve disorders and chronic atrial fibrillation (CAF) during mitral valve operation in the light of the literature. Methods. Between June 2004 and April 2009, 25 patients with mitral valve diseases associated with chronic atrial fibrillation underwent valve replacement and endocardial RFA with Medtronic cardioblade ablation pen at our clinic. There were 12 (%48) male and 13 (%52) female patients ranging in age from 23 to 67 years, with a mean age of 43.2 ± 10.6 years. The functional capacity of the patients were Class II in 6 (%24), Class III in 16 (%64), Class IV in 3 (%12) according the NYHA functional classification. At the preoperative period all patients were evaluated by 12 lead electrocardiography (ECG) and transthorasic echocardiography (TTE). For the patients over 40 years old, coronary angiography was performed to rule out concomitant coranary artery disease. The patients were evaluated at the 1st, 3rd, 6th, 9th months and annually by 12 lead ECG, TTE and as needed Holter monitarization after discharging. Results. There was not any complication related with the ablation technique. There were no operative or early postoperative deaths (within 30 days). Thirteen patients reverted to sinus rhythm postoperatively. But SVT was seen in 3 patients, and they were treated with antiarrhythmic drugs. The remaining 9 patients were in AF. The mean follow up period is 9 months. During the follow up period, 16 patients were noted to be in normal sinus rhythm. Conclusion. RFA can be a useful and efficient technique for restoring normal sinus rhythm and atrial functions after mitral valve surgery performed in patients who have mitral valve disease associated with chronic atrial fibrillation. But further studies with larger number of patients are needed to confirm our results.
Key words: Radiofrequency catheter ablation, atrial fibrillation, mitral valve
Özet
Amaç. Kronik Atriyal Fibrilasyonlu, mitral kapak hastalığı bulunan ve kliniğimizde mitral kapak replasmanı yapılan hastalarda intraoperatif uyguladığımız Radyofrekans ablasyonunun (RF) etkinliğinin belirlenmesi, kısa ve orta dönem sonuçlarının literatür ile karşılaştırılarak değerlendirilmesi amaçlanmıştır. Yöntem. Haziran 2004 ve Nisan 2009 tarihleri arasında kliniğimizde kronik atriyal fibrilasyonlu 25 hastaya Medtronic cardioblade cerrahi ablasyon kalemi ile radyofrekans ablasyon tedavisi uygulandı. Hastaların 12'si (%48) erkek 13'ü (%52) bayandı. Ortalama yaş 43,2 ± 10,6 (23-67) idi. Hastaların fonksiyonel kapasiteleri NYHA sınıflamasına göre 6'sı (%24) sınıf II, 16'sı (%64) sınıf III, 3'ü (12) ise sınıf IV idi. Bütün hastalara standart 12 derivasyonlu EKG ve ekokardiyografi yapıldı. Kırk yaş üzeri hastalara muhtemel bir koroner arter hastalığını saptayabilmek amacı ile koroner anjiyografi yapıldı. Hastalar taburcu edildiklerinden itibaren 1.ay, 3.ay, 6.ay ve 9.aylarda standart 12 Derivasyonlu EKG, Transtorasik Ekokardiyografi ile ve gereğinde Holter monitarizasyonu ile takip edildi. Bulgular. Uygulanan yöntemden kaynaklanan herhangi bir komplikasyon gözlenmedi. Ameliyat sırasında ve hastanede ölüm olmadı. Ameliyat sonrası 13 hastada sinüs ritmi sağlandı. Hastaların 3 ünde postoperatif dönemde SVT gelişti. Antiaritmik tedavi sonrası hastalarda sinüs ritmi tesis edildi. Hastalarımızın 16'sı sinüs ritmi ile taburcu edildi. Ortalama takip süresi 9 aydı. 9 aylık takip sonunda 16 hastamız sinüs ritminde kaldı. Sonuç. AF'nin eşlik ettiği romatizmal mitral kapak hastalarında mitral kapak cerrahisi sonrası radyofrekans ablasyon tedavisi sinüs ritminin ve atriyal fonksiyonların geri dönmesinde etkili ve yararlı bir yöntem olabilir ancak sonuçların doğrulanması için daha geniş vaka sayılı çalışmalar gerekmektedir..
Anahtar Sözcükler: Radyofrekans katater ablasyon, atriyal fibrilasyon, mitral kapak
BACKGROUND: The aim of these study is to evaluate the endocardial radiofrequency ablation for the patients with mitral valve disorders and cronic atrial fibrilation during mitral valve operation
MATERIALS AND METHODS: Between june 2004 and April 2009; 25 patients with mitral valve diseases associated chronic atrial fibrilation underwent valve replacement and endocardial radiofrequency ablation with cardioblade meditronic ablation pen at our clinic. There were 12 (%48) male and 13 (%52) female patients ranging in age from 23 to 67 years, with a mean age of 43,2 ± 10,6 years. The functional capacity of the patients were Class II in 6 (%24), Class III in 16 (%64) ,Class IV in 3 (%12) according the NYHA functional classification. At the preoperative period all patients were evaluated by 12 lead ECG, Transthorasic Ecocardiography (TTE) .For the patients over 40 years old coronary angiography was performed to rule out concomitant coranary artery disease. The patients were evalueted 1st., 3th, 6th, 9th months and annualy bye 12 lead ECG, TTE and as needed Holter monitarization after discharging.
RESULTS: There were no complication related to the ablation technique. There were no operative or early postoperative deaths (within in 30 days). Thirteen patients reverted to sinus rhytm postoperatively. But SVT was seen in 3 patients, and they were treated with antiarihtymic drugs.The remaining 9 patients were in AF. The mean follow up period is 9 months. During the fallow up period, 16 patients were noted to be in normal sinus rhytm.
CONCLUSION: Radiofrequency Ablation is an efficient and useful technique. A good restore rate of normal sinus rhytm and atrial functions can be achieved by radiofrequency ablation technique in patients presenting with rheumatic valve disease.
Primary Language | English |
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Journal Section | Surgical Science Research Articles |
Authors | |
Publication Date | January 7, 2010 |
Published in Issue | Year 2010Volume: 32 Issue: 4 |