Biatrial Ablation versus Right Atrial Ablation in the Surgical Treatment of Atrial Fibrillation for Adult Patients with Atrial Septal Defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGZhao-lei ,  MEIJv , MANan , DINGFang-bao , TANGMin , ZHANGJun-wen , LIUHao

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding author：

MEIJv, Email: ju_mei63@126.com

Keywords：

Atrial fibrillation; Atrial septal defect; Radiofrequency ablation

DOI：

10.7507/1007-4848.20140084

Video：

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Objective To compare clinical outcomes between biatrial ablation and right atrial ablation in the surgical treatment of atrial fibrillation (AF)for adult patients with atrial septal defect (ASD). Methods Clinical data of 47 patients with ASD and AF who underwent surgical ASD repair and radiofrequency ablation from January 2007 to December 2012 were retrospectively analyzed. There were 20 male and 27 female patients with their age of 35-76 years. AF duration ranged from 3 months to 15 years. There were 18 patients with persistent AF and 29 patients with long-standing persistent AF. There were 10 patients with mild-to-moderate or more severe mitral regurgitation (MR), and 28 patients with mild-to-moderate or more severe tricuspid regurgitation (TR). According to different surgical strategies, all the 47 patients were divided into 2 groups. In right atrial ablation group, there were 19 patients who received ASD repair and right atrial ablation. In biatrial ablation group, there were 28 patients who received ASD repair and biatrial ablation. For patients with mild-to-moderate or more severe MR or TR, concomitant mitral or tricuspid valvuloplasty was performed. All the patients received 24-hour Holter monitoring at 3, 6 and 12 months after discharge, and were intermittently followed up thereafter. Results Cardio-pulmonary bypass time, aortic cross-clamping time and postoperative hospital stay of biatrial ablation group were significantly longer than those of right atrial ablation group. But there was no statistical difference in postoperative morbidity or recovery between the 2 groups. After heart rebeating, there were 25 patients (89.3%)with sinus rhythm (SR)and 3 patients with junc-tional rhythm (JR), and none of the patients had AF in biatrial ablation group. There were 14 patients (73.7%)with SR, 2 patients with JR and 3 patients with AF in right atrial ablation group. At discharge, 28 patients (100%)in biatrial ablation group had SR, and in right atrial ablation group there were 15 patients (78.9%)with SR and 4 patients with AF relapse (P=0.045). All the patients were followed up for 3-75 months, and there was no death or residual ASD shunt during follow-up. Two patients had mild-to-moderate or more severe MR, and 4 patients had mild-to-moderate or more severe TR. Cumulative SR maintenance rate of biatrial ablation group (87.7%±6.7%)was significantly higher than that of right atrial ablation group (47.4%±11.5%, P=0.003)at 2 years after discharge. Conclusion For adult patients with ASD and AF, biatrial ablation can produce better clinical outcomes than right atrial ablation without increasing surgical risks.

Citation： JIANGZhao-lei, MEIJv, MANan, DINGFang-bao, TANGMin, ZHANGJun-wen, LIUHao. Biatrial Ablation versus Right Atrial Ablation in the Surgical Treatment of Atrial Fibrillation for Adult Patients with Atrial Septal Defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 296-301. doi: 10.7507/1007-4848.20140084 Copy

1.	Loomba RS, Chandrasekar S, Sanan P, et al. Association of atrial tachyarrhythmias with atrial septal defect, Ebstein's anomaly and Fontan patients. Expert Rev Cardiovasc Ther, 2011, 9 (7):887-893.
2.	Bouchardy J, Therrien J, Pilote L, et al. Atrial arrhythmias in adults with congenital heart disease. Circulation, 2009, 120 (17):1679-1686.
3.	Gatzoulis M, Freeman MA, Siu SC, et al. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med, 1999, 340 (11):839-846.
4.	Murakami M, Okada H, Nishida M, et al. Right atrial separation effect for chronic atrial fibrillation with atrial septal defect:report of four cases. Ann Thorac Cardiovasc Surg, 2006, 12 (3):210-212.
5.	Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339 (10):659-666.
6.	Voeller RK, Bailey MS, Zierer A, et al. Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure. J Thorac Cardiovasc Surg, 2008, 135 (4):870-877.
7.	Dunning J, Nagendran M, Alfieri OR, et al. Guideline for the surgical treatment of atrial fibrillation. Eur J Cardiothorac Surg, 2013, 44 (5):777-791.
8.	Soni LK, Cedola SR, Cogan J, et al. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbi-dity. J Thorac Cardiovasc Surg, 2013, 145 (2):356-361.
9.	Kim JB, Bang JH, Jung SH, et al. Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2011, 92 (4):1397-1405.
10.	Onorati F, Esposito A, Messina G, et al. Right isthmus ablation reduces supraventricular arrhythmias after surgery for chronic atrial fibrillation. Ann Thorac Surg, 2008, 85 (1):39-48.
11.	Giamberti A, Chessa M, Foresti S, et al. Combined atrial septal defect surgical closure and irrigated radiofrequency ablation in adult patients. Ann Thorac Surg, 2006, 82 (4):1327-1331.
12.	Harada A, Ida T, Ikeshita M. Right atrial isolation for atrial fibrill-ation associated with atrial septal defect. Ann Thorac Surg, 1998, 65 (6):1766-1768.
13.	王志农, 汪曾炜, 李莉, 等.右侧迷宫术治疗先天性心脏病合并心房颤动的初步经验.中华心律失常学杂志, 2006, 10 (1):19-23.
14.	Burstein B, Nattel S. Atrial fibrosis:mechanisms and clinical relev-ance in atrial fibrillation. J Am Coll Cardiol, 2008, 51 (8):802-809.
15.	Xu J, Cui G, Esmailian F, et al. Atrial extracellular matrix remodeling and the maintenance of atrial fibrillation. Circulation, 2004, 109 (3):363-368.
16.	Henry L, Ad N. The surgical treatment for atrial fibrillation:ablation technology and surgical approaches. Rambam Maimonides Med J, 2013, 4 (3):e21.
17.	Basu S, Nagendran M, Maruthappu M. How effective is bipolar radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery? Interact Cardiovasc Thorac Surg, 2012, 15 (4):741-748.
18.	崔永强, 孟旭, 李岩, 等.心脏直视手术中双极射频消融治疗心房颤动91例分析.中华外科杂志, 2009, 47 (7):533-536.
19.	Speechly-Dick ME, John R, Pugsley WB, et al. Secundum atrial septal defect repair:long-term surgical outcome and the problem of late mitral regurgitation. Postgrad Med J, 1993, 69 (818):912-915.
20.	Toyono M, Pettersson GB, Matsumura Y, et al. Preoperative and postoperative mitral valve prolapse and regurgitation in adult patients with secundum atrial septal defects. Echocardiography, 2008, 25 (10):1086-1093.

1. Loomba RS, Chandrasekar S, Sanan P, et al. Association of atrial tachyarrhythmias with atrial septal defect, Ebstein's anomaly and Fontan patients. Expert Rev Cardiovasc Ther, 2011, 9 (7):887-893.
2. Bouchardy J, Therrien J, Pilote L, et al. Atrial arrhythmias in adults with congenital heart disease. Circulation, 2009, 120 (17):1679-1686.
3. Gatzoulis M, Freeman MA, Siu SC, et al. Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med, 1999, 340 (11):839-846.
4. Murakami M, Okada H, Nishida M, et al. Right atrial separation effect for chronic atrial fibrillation with atrial septal defect:report of four cases. Ann Thorac Cardiovasc Surg, 2006, 12 (3):210-212.
5. Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339 (10):659-666.
6. Voeller RK, Bailey MS, Zierer A, et al. Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure. J Thorac Cardiovasc Surg, 2008, 135 (4):870-877.
7. Dunning J, Nagendran M, Alfieri OR, et al. Guideline for the surgical treatment of atrial fibrillation. Eur J Cardiothorac Surg, 2013, 44 (5):777-791.
8. Soni LK, Cedola SR, Cogan J, et al. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbi-dity. J Thorac Cardiovasc Surg, 2013, 145 (2):356-361.
9. Kim JB, Bang JH, Jung SH, et al. Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2011, 92 (4):1397-1405.
10. Onorati F, Esposito A, Messina G, et al. Right isthmus ablation reduces supraventricular arrhythmias after surgery for chronic atrial fibrillation. Ann Thorac Surg, 2008, 85 (1):39-48.
11. Giamberti A, Chessa M, Foresti S, et al. Combined atrial septal defect surgical closure and irrigated radiofrequency ablation in adult patients. Ann Thorac Surg, 2006, 82 (4):1327-1331.
12. Harada A, Ida T, Ikeshita M. Right atrial isolation for atrial fibrill-ation associated with atrial septal defect. Ann Thorac Surg, 1998, 65 (6):1766-1768.
13. 王志农, 汪曾炜, 李莉, 等.右侧迷宫术治疗先天性心脏病合并心房颤动的初步经验.中华心律失常学杂志, 2006, 10 (1):19-23.
14. Burstein B, Nattel S. Atrial fibrosis:mechanisms and clinical relev-ance in atrial fibrillation. J Am Coll Cardiol, 2008, 51 (8):802-809.
15. Xu J, Cui G, Esmailian F, et al. Atrial extracellular matrix remodeling and the maintenance of atrial fibrillation. Circulation, 2004, 109 (3):363-368.
16. Henry L, Ad N. The surgical treatment for atrial fibrillation:ablation technology and surgical approaches. Rambam Maimonides Med J, 2013, 4 (3):e21.
17. Basu S, Nagendran M, Maruthappu M. How effective is bipolar radiofrequency ablation for atrial fibrillation during concomitant cardiac surgery? Interact Cardiovasc Thorac Surg, 2012, 15 (4):741-748.
18. 崔永强, 孟旭, 李岩, 等.心脏直视手术中双极射频消融治疗心房颤动91例分析.中华外科杂志, 2009, 47 (7):533-536.
19. Speechly-Dick ME, John R, Pugsley WB, et al. Secundum atrial septal defect repair:long-term surgical outcome and the problem of late mitral regurgitation. Postgrad Med J, 1993, 69 (818):912-915.
20. Toyono M, Pettersson GB, Matsumura Y, et al. Preoperative and postoperative mitral valve prolapse and regurgitation in adult patients with secundum atrial septal defects. Echocardiography, 2008, 25 (10):1086-1093.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Biatrial Ablation versus Right Atrial Ablation in the Surgical Treatment of Atrial Fibrillation for Adult Patients with Atrial Septal Defect

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