Objective To evaluate the effect and possibility of surgical ablation of the pulmonary vein orifices under direct vision with transballoon ultrasound ablation catheter for patients with permanent atrial fibrillation and rheumatic valve disease.
Methods 21 consecutive patients with rheumatic valve disease and permanent atrial fibrillation undergoing mitral valve replacement surgery from December 2002 to September 2003 were enrolled for this study. All cases were divided into 2 groups by whether or not receiving an additive pulmonary vein ablation procedure. The test group (6 male, 5 female, aged 51.55±7.83 years, atrial fibrillation duration 5.50±5.40 years, left atrial diameter 7.27±1.39 cm, LVEF 53.95±4.54% and NYHA class II–IV) undertook a surgical isolation of the pulmonary vein orifices by using a transballoon ultrasound ablation catheter addition to routine mitral valve replacement. The control group (3 male, 7 female, aged 53.30±7.86 years, atrial fibrillation duration 4.50±3.47 years, left atrial diameter 6.74±0.62 cm, LVEF 56.91±3.78% and NYHA class II–IV) received the valve replacement surgery alone.
Results There were not any complications in both groups. With an electrical cardioversion 3 months after the surgery, 73% patients in the ultrasound ablation group were free from AF over 1 year while only 10% patients in control group (p=0.003). During an average follow-up duration of 69.92±4.61 months, 65.6% were in sinus rhythm in ultrasound ablation group while none in the control group. Left atrial volume decreased significantly at 5 year after surgery compared to 3 months after surgery in the test group (78.83±32.39 cm3 VS 150.78±52.32 cm3 p<0.05), and the end systolic diameter (LAESD) and end diastolic diameter? (LAEDD) also decreased (3.92±0.43 cm vs 5.09±0.98 cm, p<0.05; and 3.92±0.43 cm vs 4.46±1.15 cm, p<0.05, respectively).
Conclusions Ablation of the orifices of the pulmonary veins under direct vision with transballoon ultrasound ablation catheter during mitral valve surgery is effective to maintain sinus rhythm after electrical cardioversion and can be performed safely. The function of left atrial and cardiac output improves during long term follow-up.
- Through-the-Balloon ultrasound ablation
- pulmonary veins
- atrial fibrillation