The efficiency of radiofrequency ablation therapy for the treatment of atrial fibrillation during concomitant mitral valve surgery; short and midterm results
Öz
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
Anahtar Kelimeler
Kaynakça
- Lip GY, Beevers DG, Singh SP, Watson RD. ABC of Atriyal fibrilation. Aetiology, pathophsiology and clinical features BMJ 1995; 311: 1425-8.
- Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Lewy D. Impact of atrial fibrilation on the risk of death; The Framingham Heart study. Circulation 2003; 104: 234–43.
- Lévy S, Breithardt G, Campbell RW, Camm AJ, Daubert JC, Allessie M, Aliot E, Capucci A, Cosio F, Crijns H, Jordaens L, Hauer RN, Lombardi F, Lüderitz B. Atrial fibrillation: current knowledge and recommendations for management. Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1998; 19: 1294-320.
- Adalet K. Atriyal Fibrilasyonun güncel farmakolojik tedavisi. Türk Kardiyoloji Derneği Araştırmaları 2002; 30: 104-8.
- Lloyd-Jones D. M, Wang T. J., Leip E. P., Martin G. Larson, Levy D, Vasan R. S, D’Agostino R. B., Massaro J. M, Beiser A, Wolf P. A, Benjamin E. J. Life time risk for development of atrial fibrilation: The Framingham Heart Study. Circulation 2004; 110: 1042-6.
- Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba W, Bash D, Schweikert R, Brachmann J, Gunther J, Gutleben K, Pisano E, Potenza D, Fanelli R, Raviele A, Themistoclakis S, Rossillo A, Bonso A, Natale A. Radiofrequency Ablation vs Antiarrhythmic Drugs as First-line Treatment of Symptomatic Atrial Fibrillation. JAMA 2005; 293: 2634-40.
- Hoscan Y. Romatizmal Mitral Kapak Hastalığında Mekanik Kapak Replasmanı Sonrası Sol Atriyal Apendiks Fonksiyonlarının Araştırılması. Uzmanlık Tezi. SDU Tıp Fak. Kardiyoloji A.D. Isparta 2003.
- Handa N, Schaff HV, Morris JJ, Anderson BJ, Kopecky SL, Enriquez-Sarano M. Outcome of mitral valve replacement and coxe maze procedure for mitral regurgitation and associated AF. J Thoracic Surgery 1999; 119: 628-32.
- Melo J, Adragão P, Neves J, Ferreira MM, Pinto MM, Rebocho MJ, Parreira L,Ramos T. Surgery for atrial fibrillation using radiofrequency catheter ablation: assessment of results at one year. Eur J Cardiothorac Surg 1999; 15: 851-4.
- Cox JL, Schuessler RB, Boineau JP. The development of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 2000; 12: 2-14.
- Viola N,Williams MR. The technology in use for the surgical ablation of atrial fibrillation. Thorac Cardivasc Surg 2002; 14: 198-205.
- Wittkampf FH, Hauer RN, Robles de Medina EO. Control of radiofrequency lesion size by power regulation. Circulation 1989; 80: 962-8.
- Nakagawa H, Yamanashi WS, Pitha JV, Arruda M, Wang X, Ohtomo K, Beckman KJ, McClelland JH, Lazzara R, Jackman WM. Comparision of invivo tissue temperature profile and lesion geometry for radiofrequency Ablation with saline – irrigated electrode versus temperature control in a thigh muscle preparation. Circulation 1995; 91: 2264-73.
- Demirkılıç U, Günay C, Bolcal C, Temizkan V, Doğancı S, Kuralay E, Tatar H. Atriyal Fibrilasyonlu Mitral kapak hastalarında Endokardiyal RF ablasyonun erken dönem sonuçları. T Klin J Cardivascular Surgery 2003; 4: 159-65.
- Akpinar B, Guden M, Sagbas E, Sanisoglu I, Ozbek U, Caynak B, Bayindir O.Combined radiofrequency modified maze and mitral valve procedure through a portaccess approach: early and mid-term results. Eur J Cardiothorac Surg. 2003; 24: 223-30.
- Mert B. Atriyal Fibrilasyonun Romatizmal Mitral Kapak Hastalığında Radyofrekans Ablasyon Katateri Kullanılarak Cerrahi Tedavisi. Uzmanlık Tezi. T.C. Sağlık Bakanlığı Kartal Koşuyolu Yüksk İhtisas Eğitim ve Araştırma Hastanesi. İstanbul/2006.
- Honnelly JH, Clubb FJ, Vaughn W, Duncan M. Morphological changes in atrial appendages removed during the maze procedure: a comparison with autopsy controls. Cardiovasc Pathol 2001: 39-42.
- Schlepper M. Identification of patients with atrial fibrillation at risk for thromboembolism. In: Olsson B, Allessie M,Campbell R, editors. Atrial fibrillation, mechanisms and therapeutic strategies. 2nd ed. Armonk (NY): Futura Publishing Co; 1994. p. 15-24.
- Ekim H, Kutay V, Akbayrak H ,Yakut C. Management of prosthetic mitral valve thrombosis .Eastern J Med 2005; 10: 10-4.
- Çaynak B, Sağbas E, Akpınar B. Atriyal Fibrilasyonun cerrahi tedavisi: uzun dönem sonuçlar. Türk Gögüs Kalp Damar Cerrahisi Dergisi 2006; 2: 234-9.
- Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thoracic Surg 1993; 56: 539-49.
- Izumoto H, Kawazoe K, Kitahara H, Kamata J. Operative results after the Cox/maze procedure combined with a mitral valve operation. Ann Thorac Surg 1998; 66: 800-4.
- Dittrich HC, Erickson JS, Schneiderman T, Blacky AR, Savides T, Nicod PH. Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation. Am J Cardiol 1989; 63: 193-7.
- Kabukçu M,Yanık E Atriyal Fibrilasyonlu Romatizmal mitral kapak replasmanı olgularında sinüs ritmi sağlanmasının pulmoner hemodinami ve fonksiyonel duruma etkisi T klinikleri J.cardivascular surgery 2001; 1: 234–7.
- Incalzi RA, Pistelli R, Fuso L, Cocchi A, Bonetti MG, Giordano A. Cardiac arrhythmias and left ventricular function in respiratory failure from chronic obstructive pulmonary disease. Chest 1990; 97: 1092-7
- Guden M,Akpınar B, Çaynak B. Left versus bi-atrial intraoperative salin irrigated radiofrequency modified maze procedure for atrial fibrilation. Card Electrophysiol Rev 2003; 7: 252-8.
- Mesana TG, Kulik A,Ruel M. Combined atrial fibrilation with mitral valve surgery J.Heart Valve Dis 2006; 15: 515–20.
- Akpınar B, Guden M, Sağbaş E. Atriyal Fibrilasyonun cerrahi tedavisi. Anadolu Kardiyoloji Dergisi 2007; 7: 65-73.
- Arı H, Binici S. BNP düzeyi AF Rekürrensi. Türk kardiyoloji derneği arastırmaları 2008; 36: 456-60.
- Keleş T, Avşar F. Bifosfanatlar ve AF riski. Türkiye Klinikleri J.Cardiovasc Surg 2009; 21: 275-8.
- Arat N. Erbaşı S, Tüfekçioğlu O, Sabah İ. Spontan Eko Kontrast. T Klin Kardiyoloji 2001, 14: 129-34.
- Sönmez B, Demirsoy E, Yılmaz O. Atrioesophagial phistula; is it an unavoidable complication of Radio frequency ablation. J Thorac Cardiovasc Surg 2003; 126: 1662-3.
THE EFFICIENCY OF RADIOFREQUENCY ABLATION THERAPY FOR THE TREATMENT OF ATRIAL FIBRILLATION DURING CONCOMINANT MITRAL VALVE SURGERY; SHORT AND MID TERM RESULTS
Öz
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.
Anahtar Kelimeler
Radyofrekans katater ablasyon atriyal fibrilasyon mitral kapak
Kaynakça
- Lip GY, Beevers DG, Singh SP, Watson RD. ABC of Atriyal fibrilation. Aetiology, pathophsiology and clinical features BMJ 1995; 311: 1425-8.
- Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Lewy D. Impact of atrial fibrilation on the risk of death; The Framingham Heart study. Circulation 2003; 104: 234–43.
- Lévy S, Breithardt G, Campbell RW, Camm AJ, Daubert JC, Allessie M, Aliot E, Capucci A, Cosio F, Crijns H, Jordaens L, Hauer RN, Lombardi F, Lüderitz B. Atrial fibrillation: current knowledge and recommendations for management. Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1998; 19: 1294-320.
- Adalet K. Atriyal Fibrilasyonun güncel farmakolojik tedavisi. Türk Kardiyoloji Derneği Araştırmaları 2002; 30: 104-8.
- Lloyd-Jones D. M, Wang T. J., Leip E. P., Martin G. Larson, Levy D, Vasan R. S, D’Agostino R. B., Massaro J. M, Beiser A, Wolf P. A, Benjamin E. J. Life time risk for development of atrial fibrilation: The Framingham Heart Study. Circulation 2004; 110: 1042-6.
- Wazni OM, Marrouche NF, Martin DO, Verma A, Bhargava M, Saliba W, Bash D, Schweikert R, Brachmann J, Gunther J, Gutleben K, Pisano E, Potenza D, Fanelli R, Raviele A, Themistoclakis S, Rossillo A, Bonso A, Natale A. Radiofrequency Ablation vs Antiarrhythmic Drugs as First-line Treatment of Symptomatic Atrial Fibrillation. JAMA 2005; 293: 2634-40.
- Hoscan Y. Romatizmal Mitral Kapak Hastalığında Mekanik Kapak Replasmanı Sonrası Sol Atriyal Apendiks Fonksiyonlarının Araştırılması. Uzmanlık Tezi. SDU Tıp Fak. Kardiyoloji A.D. Isparta 2003.
- Handa N, Schaff HV, Morris JJ, Anderson BJ, Kopecky SL, Enriquez-Sarano M. Outcome of mitral valve replacement and coxe maze procedure for mitral regurgitation and associated AF. J Thoracic Surgery 1999; 119: 628-32.
- Melo J, Adragão P, Neves J, Ferreira MM, Pinto MM, Rebocho MJ, Parreira L,Ramos T. Surgery for atrial fibrillation using radiofrequency catheter ablation: assessment of results at one year. Eur J Cardiothorac Surg 1999; 15: 851-4.
- Cox JL, Schuessler RB, Boineau JP. The development of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 2000; 12: 2-14.
- Viola N,Williams MR. The technology in use for the surgical ablation of atrial fibrillation. Thorac Cardivasc Surg 2002; 14: 198-205.
- Wittkampf FH, Hauer RN, Robles de Medina EO. Control of radiofrequency lesion size by power regulation. Circulation 1989; 80: 962-8.
- Nakagawa H, Yamanashi WS, Pitha JV, Arruda M, Wang X, Ohtomo K, Beckman KJ, McClelland JH, Lazzara R, Jackman WM. Comparision of invivo tissue temperature profile and lesion geometry for radiofrequency Ablation with saline – irrigated electrode versus temperature control in a thigh muscle preparation. Circulation 1995; 91: 2264-73.
- Demirkılıç U, Günay C, Bolcal C, Temizkan V, Doğancı S, Kuralay E, Tatar H. Atriyal Fibrilasyonlu Mitral kapak hastalarında Endokardiyal RF ablasyonun erken dönem sonuçları. T Klin J Cardivascular Surgery 2003; 4: 159-65.
- Akpinar B, Guden M, Sagbas E, Sanisoglu I, Ozbek U, Caynak B, Bayindir O.Combined radiofrequency modified maze and mitral valve procedure through a portaccess approach: early and mid-term results. Eur J Cardiothorac Surg. 2003; 24: 223-30.
- Mert B. Atriyal Fibrilasyonun Romatizmal Mitral Kapak Hastalığında Radyofrekans Ablasyon Katateri Kullanılarak Cerrahi Tedavisi. Uzmanlık Tezi. T.C. Sağlık Bakanlığı Kartal Koşuyolu Yüksk İhtisas Eğitim ve Araştırma Hastanesi. İstanbul/2006.
- Honnelly JH, Clubb FJ, Vaughn W, Duncan M. Morphological changes in atrial appendages removed during the maze procedure: a comparison with autopsy controls. Cardiovasc Pathol 2001: 39-42.
- Schlepper M. Identification of patients with atrial fibrillation at risk for thromboembolism. In: Olsson B, Allessie M,Campbell R, editors. Atrial fibrillation, mechanisms and therapeutic strategies. 2nd ed. Armonk (NY): Futura Publishing Co; 1994. p. 15-24.
- Ekim H, Kutay V, Akbayrak H ,Yakut C. Management of prosthetic mitral valve thrombosis .Eastern J Med 2005; 10: 10-4.
- Çaynak B, Sağbas E, Akpınar B. Atriyal Fibrilasyonun cerrahi tedavisi: uzun dönem sonuçlar. Türk Gögüs Kalp Damar Cerrahisi Dergisi 2006; 2: 234-9.
- Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thoracic Surg 1993; 56: 539-49.
- Izumoto H, Kawazoe K, Kitahara H, Kamata J. Operative results after the Cox/maze procedure combined with a mitral valve operation. Ann Thorac Surg 1998; 66: 800-4.
- Dittrich HC, Erickson JS, Schneiderman T, Blacky AR, Savides T, Nicod PH. Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation. Am J Cardiol 1989; 63: 193-7.
- Kabukçu M,Yanık E Atriyal Fibrilasyonlu Romatizmal mitral kapak replasmanı olgularında sinüs ritmi sağlanmasının pulmoner hemodinami ve fonksiyonel duruma etkisi T klinikleri J.cardivascular surgery 2001; 1: 234–7.
- Incalzi RA, Pistelli R, Fuso L, Cocchi A, Bonetti MG, Giordano A. Cardiac arrhythmias and left ventricular function in respiratory failure from chronic obstructive pulmonary disease. Chest 1990; 97: 1092-7
- Guden M,Akpınar B, Çaynak B. Left versus bi-atrial intraoperative salin irrigated radiofrequency modified maze procedure for atrial fibrilation. Card Electrophysiol Rev 2003; 7: 252-8.
- Mesana TG, Kulik A,Ruel M. Combined atrial fibrilation with mitral valve surgery J.Heart Valve Dis 2006; 15: 515–20.
- Akpınar B, Guden M, Sağbaş E. Atriyal Fibrilasyonun cerrahi tedavisi. Anadolu Kardiyoloji Dergisi 2007; 7: 65-73.
- Arı H, Binici S. BNP düzeyi AF Rekürrensi. Türk kardiyoloji derneği arastırmaları 2008; 36: 456-60.
- Keleş T, Avşar F. Bifosfanatlar ve AF riski. Türkiye Klinikleri J.Cardiovasc Surg 2009; 21: 275-8.
- Arat N. Erbaşı S, Tüfekçioğlu O, Sabah İ. Spontan Eko Kontrast. T Klin Kardiyoloji 2001, 14: 129-34.
- Sönmez B, Demirsoy E, Yılmaz O. Atrioesophagial phistula; is it an unavoidable complication of Radio frequency ablation. J Thorac Cardiovasc Surg 2003; 126: 1662-3.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 7 Ocak 2010 |
| Yayımlandığı Sayı | Yıl 2010Cilt: 32 Sayı: 4 |