Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

Abstract Objective: To assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated. Methods: Retrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated. Results: After one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%. Conclusion: Atrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.

摘要
研究目的：评估接受同期心房颤动外科治疗的风湿性瓣膜病患者术后1年窦性心律的维持情况及其相关预测因素，同时评估术后1年的手术死亡率、总体生存率及卒中发生情况。
研究方法：本研究为回顾性纵向观察性研究，纳入2013年1月至2014年12月期间接受风湿性二尖瓣手术联合单极或双极射频消融治疗心房颤动的103例患者。考察指标包括患者年龄、性别、心功能分级（NYHA，New York Heart Association）、心房颤动类型、欧洲心脏手术风险评估系统（EuroSCORE）、心房颤动病程、卒中病史、左心房内径、左心室射血分数、体外循环时间、心肌缺血时间及射频消融类型。
研究结果：术后1年时，66.3%的患者维持窦性心律。出院时为窦性心律、术前左心房内径更小以及采用双极射频消融，均与术后1年更高的窦性心律维持概率相关。本研究的手术死亡率为7.7%，术后1年总体生存率为92.3%，卒中发生率为1%。
研究结论：风湿性二尖瓣手术联合心房颤动外科消融术可使63.1%的患者术后1年维持窦性心律。出院时为窦性心律是该心律得以长期维持的预测因素。左心房扩大以及采用单极射频消融则与更低的窦性心律维持概率相关。本研究7.7%的手术死亡率、92.3%的1年总体生存率及无卒中生存率，证实该术式具有优异的临床治疗效果。