Relationship between Postoperative Atrial Function and Fibrosis of Patients after Mitral Valve Replacement and Concomitant Radiofrequency Ablation for Atrial Fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 JINYan , WANGHui-shan , WANGZeng-wei , LIXin-min , YINZong-tao , ZHUYan , YUYan

Department of Cardiac Surgery, General Hospital of Shenyang Military Area Command, Shenyang 110840, P. R. China;

Corresponding author：

JINYan, Email: jinyan4158@vip.sina.com

Keywords：

Mitral valve replacement; Radiofrequency ablation; Atrial fibrosis

DOI：

10.7507/1007-4848.20140168

Video：

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Objective To investigate the restoration of left atrial function and its relationship with atrial fibrosis of patients after mitral valve replacement (MVR)and concomitant radiofrequency ablation (RFA)for atrial fibrillation (AF). Methods Clinical data of 32 patients with mitral valve disease and chronic AF who underwent surgical treatment in General Hospital of Shenyang Military Area Command from January to August 2010 were retrospectively analyzed in this cohort study. There were 11 male and 21 female patients with their age of 49.8±8.7 years. There were 14 patients with rheumatic mitral stenosis (MS), 8 patients with rheumatic MS and mitral regurgitation, and 10 patients with mitral valve prolapse. Preoperative AF duration was 3.6±4.6 years. All the patients received MVR and concomitant RFA for AF. According to the cutting off extent of left atrial fibrosis (10.9%), all the 32 patients were divided into 2 groups. There were 19 patients with more severe left atrial fibrosis ( > 10.9%)in group A and 13 patients with milder left atrial fibrosis ( < 10.9%)in group B. Immunohistochemistry was performed to examined left atrial fibrosis, and echocardiography was performed to examined the structure and function of left atrium. Results There was no perioperative death. Cardiopulmonary bypass time was 84.6±22.6 minutes, aortic cross-clamping time was 47.6±15.6 minutes, and ICU stay was 3.2±1.5 days. All the 32 patients were followed up for longer than 6 months (1.3±0.6 years). The extent of left atrial fibrosis of the 32 patients was 4.8%-18.3% (10.7%±4.2%). There was no statistical difference in left atrial diameter (LAD), left atrial fractional area change (LAFAC)or mitral annular motion between group A and group B preoperatively and 3 months after surgery respectively (P > 0.05). At 6 month after surgery, LAD of group B was significantly smaller than that of group A (P < 0.05), late diastolic mitral annular velocity (Am)of group B was significantly higher than that of group A (P < 0.05), and there was also some improvement in LAFAC of group B compared with group A (P=0.067). Among the 32 patients, 28 patients (87.5%)restored sinus rhythm (SR)3 months after surgery, and 21 patients (65.6%)maintained SR longer than 6 months after surgery. Patients in group B were more likely to maintain SR than patients in group A (P=0.010). Conclusion Improvement of left atrial function can be observed 6 month after MVR and concomitant RFA for AF, which is related to the extent of left atrial fibrosis.

Citation： JINYan, WANGHui-shan, WANGZeng-wei, LIXin-min, YINZong-tao, ZHUYan, YUYan. Relationship between Postoperative Atrial Function and Fibrosis of Patients after Mitral Valve Replacement and Concomitant Radiofrequency Ablation for Atrial Fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 587-592. doi: 10.7507/1007-4848.20140168 Copy

1.	Platonov PG, Mitrofanova LB, Orshanskaya V, et al. Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J Am Coll Cardiol, 2011, 58(21):2225-2232.
2.	Corradi D, Callegari S, Maestri R, et al. Differential structural remo-deling of the left-atrial posterior wall in patients affected by mitral regurgitation with or without persistent atrial fibrillation:a morphological and molecular study. J Cardiovasc Electrophysiol, 2012, 23(3):271-279.
3.	Boldt A, Wetzel U, Lauschke J, et al. Fibrosis in left atrial tissue of patients with atrial fibrillation with and without underlying mitral valve disease. Heart, 2004, 90(4):400-405.
4.	Everett TH, Olgin JE. Atrial fibrosis and the mechanisms of atrial fibrillation. Heart Rhythm, 2007, 4(3 Suppl):S24-S27.
5.	刘玉学, 王欣.心房颤动中心房重构机制的研究进展.中国胸心血管外科临床杂志, 2009, 16(3):218-222.
6.	Todd DM, Skanes AC, Guiraudon G, et al. Role of the posterior left atrium and pulmonary veins in human lone atrial fibrillation:electrophysiological and pathological data from patients undergoing atrial fibrillation surgery. Circulation, 2003, 108(25):3108-3114.
7.	Corradi D, Callegari S, Benussi S, et al. Myocyte changes and their left atrial distribution in patients with chronic atrial fibrillation related to mitral valve disease. Hum Pathol, 2005, 36(10):1080-1089.
8.	Qian YJ, Meng J, Tang H, et al. Different structural remodelling in atrial fibrillation with different types of mitral valvular diseases. Eu ropace, 2010, 12(3):371-377.
9.	Large SR, Hosseinpour AR, Wisbey C, et al. Spontaneous cardioversion and mitral valve repair:a role for surgical cardioversion (Cox-maze)? Eur J Cardiothorac Surg, 1997, 11(1):76-80.
10.	Obadia JF, el Farra M, Bastien OH, et al. Outcome of atrial fibrillation after mitral valve repair. J Thorac Cardiovasc Surg, 1997, 114(2):179-185.
11.	Handa N, Schaff HV, Morris JJ, et al. Outcome of valve repair and the Cox maze procedure for mitral regurgitation and associated atrial fibrillation. J Thorac Cardiovasc Surg, 1999, 118(4):628-635.
12.	Kannel WB, Wolf PA, Benjamin EJ, et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation:population-based estimates. Am J Cardiol, 1998, 82(8A):2N-9N.
13.	Jessurun ER, van Hemel NM, Kelder JC, et al. Mitral valve surgery and atrial fibrillation:is atrial fibrillation surgery also needed? Eur J Cardiothorac Surg, 2000, 17(5):530-537.
14.	Isobe F, Kawashima Y. The outcome and indications of the Cox maze Ⅲ procedure for chronic atrial fibrillation with mitral valve disease. J Thorac Cardiovasc Surg, 1998, 116(2):220-227.
15.	Kosakai Y, Kawaguchi AT, Isobe F, et al. Modified maze procedure for patients with atrial fibrillation undergoing simultaneous open heart surgery. Circulation, 1995, 92(9 Suppl):Ⅱ359-Ⅱ364.
16.	Raanani E, Albage A, David TE, et al. The efficacy of the Cox/maze procedure combined with mitral valve surgery:a matched control study. Eur J Cardiothorac Surg, 2001, 19(4):438-442.
17.	von Oppell UO, Masani N, O'Callaghan P, et al. Mitral valve surgery plus concomitant atrial fibrillation ablation is superior to mitral valve surgery alone with an intensive rhythm control strategy. Eur J Cardiothorac Surg, 2009, 35(4):641-650.
18.	Govindan M, Kiotsekoglou A, Saha SK, et al. Validation of echocardiographic left atrial parameters in atrial fibrillation using the index beat of preceding cardiac cycles of equal duration. J Am Soc Echocardiogr, 2011, 24(10):1141-1147.
19.	Hirose T, Kawasaki M, Tanaka R, et al. Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset non-valvular atrial fibrillation:results from a prospective study in 580 adults. Eur Heart J Cardiovasc Imaging, 2012, 13(3):243-250.
20.	Rodrigues AC, Scannavacca MI, Caldas MA, et al. Left atrial function after ablation for paroxysmal atrial fibrillation. Am J Cardiol, 2009, 103(3):395-398.
21.	Yoon JH, Moon J, Chung Hm, et al. Left atrial function assessed by Doppler echocardiography rather than left atrial volume predicts recurrence in patients with paroxysmal atrial fibrillation. Clin Cardiol, 2013, 36(4):235-240.
22.	Yoshida N, Okamoto M, Hirao H, et al. Efficacy of pulmonary vein isolation on left atrial function in paroxysmal and persistent atrial fibrillation and the dependency on its baseline function. Echocardiography, 2013, 30(7):744-750.
23.	Dagres N, Hindricks G, Kottkamp H, et al. Effect of atrial fibrillation ablation on left atrial contractile function in patients with paroxysmal atrial fibrillation and a relatively well preserved atrial function. Acta Cardiol, 2009, 64(2):167-169.
24.	刘玉学, 王巍, 王欣, 等.心房纤维化程度对风湿性心脏病永久性心房颤动射频消融治疗疗效的影响.中国胸心血管外科临床杂志, 2010, 17(4):267-272.
25.	Donal E, Ollivier R, Veillard D, et al. Left atrial function assessed by trans-thoracic echocardiography in patients treated by ablation for a lone paroxysmal atrial fibrillation. Eur J Echocardiogr, 2010, 11(10):845-852.
26.	Boyd AC, Schiller NB, Ross DL, et al. Segmental atrial contraction in patients restored to sinus rhythm after cardioversion for chronic atrial fibrillation:a colour Doppler tissue imaging study. Eur J Echocardiogr, 2008, 9(1):12-17.

1. Platonov PG, Mitrofanova LB, Orshanskaya V, et al. Structural abnormalities in atrial walls are associated with presence and persistency of atrial fibrillation but not with age. J Am Coll Cardiol, 2011, 58(21):2225-2232.
2. Corradi D, Callegari S, Maestri R, et al. Differential structural remo-deling of the left-atrial posterior wall in patients affected by mitral regurgitation with or without persistent atrial fibrillation:a morphological and molecular study. J Cardiovasc Electrophysiol, 2012, 23(3):271-279.
3. Boldt A, Wetzel U, Lauschke J, et al. Fibrosis in left atrial tissue of patients with atrial fibrillation with and without underlying mitral valve disease. Heart, 2004, 90(4):400-405.
4. Everett TH, Olgin JE. Atrial fibrosis and the mechanisms of atrial fibrillation. Heart Rhythm, 2007, 4(3 Suppl):S24-S27.
5. 刘玉学, 王欣.心房颤动中心房重构机制的研究进展.中国胸心血管外科临床杂志, 2009, 16(3):218-222.
6. Todd DM, Skanes AC, Guiraudon G, et al. Role of the posterior left atrium and pulmonary veins in human lone atrial fibrillation:electrophysiological and pathological data from patients undergoing atrial fibrillation surgery. Circulation, 2003, 108(25):3108-3114.
7. Corradi D, Callegari S, Benussi S, et al. Myocyte changes and their left atrial distribution in patients with chronic atrial fibrillation related to mitral valve disease. Hum Pathol, 2005, 36(10):1080-1089.
8. Qian YJ, Meng J, Tang H, et al. Different structural remodelling in atrial fibrillation with different types of mitral valvular diseases. Eu ropace, 2010, 12(3):371-377.
9. Large SR, Hosseinpour AR, Wisbey C, et al. Spontaneous cardioversion and mitral valve repair:a role for surgical cardioversion (Cox-maze)? Eur J Cardiothorac Surg, 1997, 11(1):76-80.
10. Obadia JF, el Farra M, Bastien OH, et al. Outcome of atrial fibrillation after mitral valve repair. J Thorac Cardiovasc Surg, 1997, 114(2):179-185.
11. Handa N, Schaff HV, Morris JJ, et al. Outcome of valve repair and the Cox maze procedure for mitral regurgitation and associated atrial fibrillation. J Thorac Cardiovasc Surg, 1999, 118(4):628-635.
12. Kannel WB, Wolf PA, Benjamin EJ, et al. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation:population-based estimates. Am J Cardiol, 1998, 82(8A):2N-9N.
13. Jessurun ER, van Hemel NM, Kelder JC, et al. Mitral valve surgery and atrial fibrillation:is atrial fibrillation surgery also needed? Eur J Cardiothorac Surg, 2000, 17(5):530-537.
14. Isobe F, Kawashima Y. The outcome and indications of the Cox maze Ⅲ procedure for chronic atrial fibrillation with mitral valve disease. J Thorac Cardiovasc Surg, 1998, 116(2):220-227.
15. Kosakai Y, Kawaguchi AT, Isobe F, et al. Modified maze procedure for patients with atrial fibrillation undergoing simultaneous open heart surgery. Circulation, 1995, 92(9 Suppl):Ⅱ359-Ⅱ364.
16. Raanani E, Albage A, David TE, et al. The efficacy of the Cox/maze procedure combined with mitral valve surgery:a matched control study. Eur J Cardiothorac Surg, 2001, 19(4):438-442.
17. von Oppell UO, Masani N, O'Callaghan P, et al. Mitral valve surgery plus concomitant atrial fibrillation ablation is superior to mitral valve surgery alone with an intensive rhythm control strategy. Eur J Cardiothorac Surg, 2009, 35(4):641-650.
18. Govindan M, Kiotsekoglou A, Saha SK, et al. Validation of echocardiographic left atrial parameters in atrial fibrillation using the index beat of preceding cardiac cycles of equal duration. J Am Soc Echocardiogr, 2011, 24(10):1141-1147.
19. Hirose T, Kawasaki M, Tanaka R, et al. Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset non-valvular atrial fibrillation:results from a prospective study in 580 adults. Eur Heart J Cardiovasc Imaging, 2012, 13(3):243-250.
20. Rodrigues AC, Scannavacca MI, Caldas MA, et al. Left atrial function after ablation for paroxysmal atrial fibrillation. Am J Cardiol, 2009, 103(3):395-398.
21. Yoon JH, Moon J, Chung Hm, et al. Left atrial function assessed by Doppler echocardiography rather than left atrial volume predicts recurrence in patients with paroxysmal atrial fibrillation. Clin Cardiol, 2013, 36(4):235-240.
22. Yoshida N, Okamoto M, Hirao H, et al. Efficacy of pulmonary vein isolation on left atrial function in paroxysmal and persistent atrial fibrillation and the dependency on its baseline function. Echocardiography, 2013, 30(7):744-750.
23. Dagres N, Hindricks G, Kottkamp H, et al. Effect of atrial fibrillation ablation on left atrial contractile function in patients with paroxysmal atrial fibrillation and a relatively well preserved atrial function. Acta Cardiol, 2009, 64(2):167-169.
24. 刘玉学, 王巍, 王欣, 等.心房纤维化程度对风湿性心脏病永久性心房颤动射频消融治疗疗效的影响.中国胸心血管外科临床杂志, 2010, 17(4):267-272.
25. Donal E, Ollivier R, Veillard D, et al. Left atrial function assessed by trans-thoracic echocardiography in patients treated by ablation for a lone paroxysmal atrial fibrillation. Eur J Echocardiogr, 2010, 11(10):845-852.
26. Boyd AC, Schiller NB, Ross DL, et al. Segmental atrial contraction in patients restored to sinus rhythm after cardioversion for chronic atrial fibrillation:a colour Doppler tissue imaging study. Eur J Echocardiogr, 2008, 9(1):12-17.

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Relationship between Postoperative Atrial Function and Fibrosis of Patients after Mitral Valve Replacement and Concomitant Radiofrequency Ablation for Atrial Fibrillation

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