CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 3, May/June 2010
AFRICA
137
Cardiovascular Topics
Midterm results of left atrial bipolar radiofrequency
ablation combined with a mitral valve procedure in
persistent atrial fibrillation
HAYRETTIN TEKUMIT, KEMAL UZUN, ALI RIZA CENAL, CENK TATAROGLU, ADIL POLAT, ESAT AKINCI
Summary
Introduction:
The aim of the study was to assess the mid-
term results of left atrial bipolar radiofrequency ablation
combined with a mitral valve procedure in patients with
mitral valve disease and persistent atrial fibrillation.
Methods:
Between October 2006 and July 2009, 95 patients
with mitral valve disease and persistent atrial fibrillation
underwent a mitral valve procedure and left atrial bipo-
lar radiofrequency ablation. The postoperative data of the
combined procedure were collected at the time of discharge
and at one, three, six and 12 months after the operation.
Results:
Hospital mortality rate was 6.3% (six patients).
Normal sinus rhythm was achieved in 77.2% of patients
during the early postoperative period in hospital, and in
73.3, 72.0 and 75% of patients at three, six and 12 months
postoperatively, respectively. Patients were followed up for a
mean duration of 14.02
±
5.71 months (range: 6–19 months).
During this midterm follow-up period, nine patients had late
recurrence of atrial fibrillation. No risk factor was identified
for late recurrence of atrial fibrillation.
Conclusion:
Our midterm follow-up results suggest that
the addition of left atrial bipolar radiofrequency ablation
to mitral valve surgery is an effective and safe procedure to
restore sinus rhythm in patients with chronic atrial fibrilla-
tion.
Keywords:
radiofrequency ablation, atrial fibrillation, mitral
valve disease
Submitted 28/6/09, accepted 25/8/09
Cardiovasc J Afr
2010;
21
: 137–141
Atrial fibrillation (AF) is a rapid and irregular activation of the
atria so that the normal sinus rhythm disappears. Currently, it
is the most frequent form of persistent arrhythmia. Although
its incidence ranges from 0.4 to 2% in the general population,
this rate is about 10% among individuals over 60 years of age.
Atrial fibrillation is particularly common in patients with mitral
valve disease (30 to 84%) but is also detected in about 5% of
patients with aortic valve and coronary artery disease.
1
Although
most patients with persistent AF have underlying cardiovascular
disease, about 31% do not have cardiovascular disease.
2
Atrial
fibrillation may cause heart failure, thromboembolic complica-
tions, increased treatment costs and impaired quality of life, and
it represents a significant risk for mortality even after the under-
lying cardiovascular disease is treated.
3
Medical treatment has been reported to be unsuccessful in
approximately 50 and 84% of patients with permanent AF.
4
Therefore various surgical techniques, including left atrial isola-
tion, catheter ablation of the bundle of His, corridor procedure,
pulmonary button isolation and the atrial compartment operation
have been adapted to treat atrial fibrillation.
5
The Cox-Maze III
operation, which has become the gold-standard for surgical treat-
ment of atrial fibrillation, with nearly 100% success rates was
developed by James Cox and colleagues.
6
It involves the cutting
and sewing of various parts of both atria in order to block the
spread of irregular electrical activity by creating lines of isola-
tion in the atrial musculature. Unfortunately, this method needs
experience, since it is complex and time-consuming, and also has
a high rate of complications.
In recent years, alternative energy sources such as radiofre-
quency (RF), microwave, laser, bipolar cauterisation and cryo-
ablation have been developed to create isolating lines without
cutting the tissue, and thus making ablation easier. Currently, the
radiofrequency ablation technique, which was first performed
by Sie
et al
. in 1995,
7,8
and cryo-ablation have been the most
commonly used methods.
The aim of this study was to assess the midterm results of left
atrial bipolar radiofrequency ablation combined with a mitral
valve procedure in patients with mitral valve disease and persist-
ent atrial fibrillation.
Methods
The study included a total of 95 patients (27 male: 27.8%, 68
female: 72.2%; age range: 20–77 years) who underwent a left
atrial radiofrequency ablation procedure combined with mitral
valve surgery between October 2006 and July 2009. The proce-
dure was performed in all patients with persistent atrial fibrilla-
tion (lasting at least six months) plus mitral valve disease, except
for AF cases with slow ventricular response. Standard 12-lead
electrocardiography, Holter ECG, transthoracic echocardiogra-
Avrupa Safak Hastanesi, Istanbul, Turkey
HAYRETTIN TEKUMIT, MD,
KEMAL UZUN, MD
ALI RIZA CENAL, MD
CENK TATAROGLU
ESAT AKINCI, MD
JFK Hospital, Istanbul, Turkey
ADIL POLAT, MD
