Surgical Treatment of Adult Secondary Atrial Septal Defect with Paroxysmal Atrial Fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAOTie-fu ¹ , WANGSheng-yu ¹ , CHENHong ¹ , ZHANGChun-xiao ¹ ,  MAHan-ying ²

1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R.China;
2. Department of Geriatric Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R.China;

Corresponding author：

MAHan-ying, Email: mahanying@126.com

Keywords：

Atrial septal defect; Atrial fibrillation; Surgical treatment

DOI：

10.7507/1007-4848.20160085

Video：

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Objective To investigate the surgical treatment of adult secondary atrial septal defect with paroxysmal atrial fibrillation. Methods We retrospectively analyzed the clinical data of 84 patients with adult secondary atrial septal underwent surgical treatment in Beijing Anzhen Hospital from January 2002 through May 2013. There were 31 males and 53 females at mean age of 56.3 (24-72) years. Eleven patients were treated by cardiopulmonary bypass operation with 6 patients by radiofrequency catheter ablation simultaneously. Seventy three patients were implanted with septal defect closure with 52 patients by radiofrequency ablation simultaneously. Rhythm of the heart was detected at the immediate postoperative period, 7 days, 3 months and 6 months after the operation. Results No preoperative death, thoraecotomy and no arrhythmic complications in all the patients no matter with or without RF occurred. In the patients with cardiopulmonary bypass operation, the time of aortic occlusion was 35.21±12.32 min, the cardiopulmonary bypass time was 45.67±16.93 min, and the ICU observation time was 11.87±12.36 hours. In the patients with septal defect closure implanted, ICU observation time was 10.93+13.67 hours. The incidences of atrial fibrillation in the patients with radiofrequency ablation on postoperative 7 days，3 months and 6 months were lower than those in the patients without radiofrequency ablation (P<0.05). Conclusion For adult secondary atrial septal defect patients with paroxysmal atrial fibrillation, no matter cardiopulmonary bypass operation or septal defect closure implanted, radiofrequency ablation at the same time is safety and can reduce incidence of recurrence of atrial fibrillation.

Citation： ZHAOTie-fu, WANGSheng-yu, CHENHong, ZHANGChun-xiao, MAHan-ying. Surgical Treatment of Adult Secondary Atrial Septal Defect with Paroxysmal Atrial Fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(4): 369-372. doi: 10.7507/1007-4848.20160085 Copy

1.	Shah D, AzharM, Oakley CM, et al. Natural history of secundum atrial septal defect in adults after medical or surgical treatment: a historical prospective study. Br Heart J, 1994, 71: 224-228.
2.	Konstantinides S, Geibel A, Olschewski M, et al. A comparison of surgical and medical therapy for artial septal defect in adults. N Engl J Med, 1995, 333: 469-473.
3.	Goeae A, Amdt M, Rocken C, et al. Calpains and cytokines infuriating human atria. Am J Physiol Heart Circ Physiol, 2002, 283(1): 264-272.
4.	王斌, 徐志云, 韩林, 等. 术前心房颤动对单纯二尖瓣置换术患者术后中远期疗效的影响. 中国胸心血管外科临床杂志, 2012, 19(6): 610-614.
5.	李菲, 孟旭. 术前左心房内径对外科射频消融术治疗心房颤动疗效的影响. 中国胸心血管外科临床杂志, 2013, 20(1): 38-42.
6.	王巍, 樊纪丹, 安君, 等. 成人房间隔缺损的外科治疗. 中国胸心血管外科临床杂志, 2011, 18(1): 92.
7.	高大中, 赵江龙. 心房颤动1533例病因及治疗策略变化分析. 中国实用内科杂志, 2007, 29(19): 1517.
8.	Wijffels MC, Kirchlof CJ, Dorland R, et al. AF begets AF: a study in awake chronically instrumented goats. Circulation, 1995, 92(7): 1954-1968.
9.	Goette A, Staack T, Rocken C, et al. Increased expression of extracellular signal-regulated kinase and angiotensin–con -vertingenzyme in human atria during atrial fibrillation. J Am Coil Cardiol, 2000, 35(6): 1669-1677.
10.	Madrid AH, Bueno MG, Rebollo JM, et a1. Use of irbesartan tomaintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: aprospective and randomized study. Circulation, 2002, 1 06(3): 331-336.
11.	Cox JL, Ad N, Palazoo T, et al. Current status of the maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg, 2000, 12(1): 13-19.
12.	张培德. 心房颤动与心房纤维化的联系.中国胸心血管外科临床杂志, 2011, 18(6): 561-564.
13.	Gatzouls M, Freeman M, Siu S, et al. Atrial arrhythmia after surgical closure of atrial septal defect in adults. N Eng J Med, 1999, 340(11): 839.
14.	Cohn LH, Chief editor. Cardiac Surgery in the Adult. 3th ed. New York: The McGraw-Hill Companies, 2008.1375-1393.
15.	Gillinov AM, Bhavani S, Blackstone EH, et al. Surgery for permanent atrial fibrillation: impact of patient factors and lesion set. Ann Thorac Surg, 2006, 82(2): 502-514.
16.	Stulak JM, Sundt TM, Dearani JA, et al. Ten-year experience with the Cox-maze procedure for atrial fibrillation how do we define success? Ann Thorac Surg, 2007, 83(4): 1319-1324.
17.	Melo J, Santiago T, Aguiar C, et al. Surgery for atrial fibrillation in patients with mitral valve disease: results at five years from the international Registry of Atrial Fibrillation Surgery. J Thorac Cardiovasc Surg, 2008, 135(4): 863-869.
18.	Sueda T, Nagata H, Orihashi K, et al. Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations. Ann Thorac Surg, 1997, 63(4): 1070-1075.

1. Shah D, AzharM, Oakley CM, et al. Natural history of secundum atrial septal defect in adults after medical or surgical treatment: a historical prospective study. Br Heart J, 1994, 71: 224-228.
2. Konstantinides S, Geibel A, Olschewski M, et al. A comparison of surgical and medical therapy for artial septal defect in adults. N Engl J Med, 1995, 333: 469-473.
3. Goeae A, Amdt M, Rocken C, et al. Calpains and cytokines infuriating human atria. Am J Physiol Heart Circ Physiol, 2002, 283(1): 264-272.
4. 王斌, 徐志云, 韩林, 等. 术前心房颤动对单纯二尖瓣置换术患者术后中远期疗效的影响. 中国胸心血管外科临床杂志, 2012, 19(6): 610-614.
5. 李菲, 孟旭. 术前左心房内径对外科射频消融术治疗心房颤动疗效的影响. 中国胸心血管外科临床杂志, 2013, 20(1): 38-42.
6. 王巍, 樊纪丹, 安君, 等. 成人房间隔缺损的外科治疗. 中国胸心血管外科临床杂志, 2011, 18(1): 92.
7. 高大中, 赵江龙. 心房颤动1533例病因及治疗策略变化分析. 中国实用内科杂志, 2007, 29(19): 1517.
8. Wijffels MC, Kirchlof CJ, Dorland R, et al. AF begets AF: a study in awake chronically instrumented goats. Circulation, 1995, 92(7): 1954-1968.
9. Goette A, Staack T, Rocken C, et al. Increased expression of extracellular signal-regulated kinase and angiotensin–con -vertingenzyme in human atria during atrial fibrillation. J Am Coil Cardiol, 2000, 35(6): 1669-1677.
10. Madrid AH, Bueno MG, Rebollo JM, et a1. Use of irbesartan tomaintain sinus rhythm in patients with long-lasting persistent atrial fibrillation: aprospective and randomized study. Circulation, 2002, 1 06(3): 331-336.
11. Cox JL, Ad N, Palazoo T, et al. Current status of the maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg, 2000, 12(1): 13-19.
12. 张培德. 心房颤动与心房纤维化的联系.中国胸心血管外科临床杂志, 2011, 18(6): 561-564.
13. Gatzouls M, Freeman M, Siu S, et al. Atrial arrhythmia after surgical closure of atrial septal defect in adults. N Eng J Med, 1999, 340(11): 839.
14. Cohn LH, Chief editor. Cardiac Surgery in the Adult. 3th ed. New York: The McGraw-Hill Companies, 2008.1375-1393.
15. Gillinov AM, Bhavani S, Blackstone EH, et al. Surgery for permanent atrial fibrillation: impact of patient factors and lesion set. Ann Thorac Surg, 2006, 82(2): 502-514.
16. Stulak JM, Sundt TM, Dearani JA, et al. Ten-year experience with the Cox-maze procedure for atrial fibrillation how do we define success? Ann Thorac Surg, 2007, 83(4): 1319-1324.
17. Melo J, Santiago T, Aguiar C, et al. Surgery for atrial fibrillation in patients with mitral valve disease: results at five years from the international Registry of Atrial Fibrillation Surgery. J Thorac Cardiovasc Surg, 2008, 135(4): 863-869.
18. Sueda T, Nagata H, Orihashi K, et al. Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations. Ann Thorac Surg, 1997, 63(4): 1070-1075.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment of Adult Secondary Atrial Septal Defect with Paroxysmal Atrial Fibrillation

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