Combined Off-pump Coronary Artery Bypass Grafting and Bipolar Radiofrequency Ablation for Atrial Fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONGShi-qiu , ZHANGJian-qun ,  XIEJin-sheng , BOPing , CAOXiang-rong , WANGSheng-xun , YANGChuan-rui

Department of Cardiac Surgery, Beijing Anzhen hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing 100029, P. R. China;

Corresponding?author：

XIEJin-sheng, Email: shoe666@sohu.com

Keywords：

Coronary artery disease; Atrial fibrillation; Off-pump coronary artery bypass grafting; Radiofrequency ablation

DOI：

10.7507/1007-4848.20140215

Video：

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Objective To evaluate surgical outcomes of combined off-pump coronary artery bypass grafting (OPCAB)and bipolar radiofrequency ablation (RFA)for atrial fibrillation (AF). Methods From January 2008 to October 2013, 49 patients with coronary artery disease and AF underwent OPCAB and concomitant Atricure bipolar RFA for AF in Beijing Anzhen Hospital. According to their AF duration, all the 49 patients were divided into 2 groups. In group A, there were 14 patients with permanent AF including 9 males and 5 females with their age of 56.7±7.5 years. In group B, there were 35 patients with paroxysmal AF including 27 males and 8 females with their age of 60.2±10.5 years. AF duration was 9.4±6.0 months. Coronary artery stenosis was 85%-100%. Ambulatory electrocardiogram and echocardiography were performed to observe AF recurrence during follow-up. Results None of the patients received intraoperative conversion operation under cardiopulmonary bypass, and there was no in-hospital death. Postoperatively, 81.6% (40/49)patients had conversion to sinus rhythm (SR)or junctional rhythm, 18.4% (9/49)patients remained AF, but none of the patients had second or third-degree atrioventricular block. A total of 139 distal anastomoses were performed with a mean of 2.8 distal anastomoses per patient. Length of hospital stay was 10-15 (12±3)days. SR was observed in 34 patients (69%)before discharge including 9 patients (64%)in group A and 25 patients (71%)in group B. All the patients (100%)were followed up for 5-12 months. 39 patients (80%)maintained SR over 6 months, including 10 patients (71%)in group A and 29 patients (83%)in group B. 44 patients (90%)maintained SR over 12 months, including 11 patients (79%)in group A and 33 patients (94%)in group B. There was no statistical difference in SR maintenance rate between the 2 groups (P > 0.05). Conclusion OPCAB and concomitant bipolar RFA for AF is safe, efficacious and feasible.

Citation： SONGShi-qiu, ZHANGJian-qun, XIEJin-sheng, BOPing, CAOXiang-rong, WANGSheng-xun, YANGChuan-rui. Combined Off-pump Coronary Artery Bypass Grafting and Bipolar Radiofrequency Ablation for Atrial Fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 748-752. doi: 10.7507/1007-4848.20140215 Copy

1.	Pradhan R, Chaudhary A, Donato AA. Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease. Am J Emerg Med, 2012, 30(7):1042-1047.
2.	范萌, 李光日, 魏鋒.不停跳下冠狀動脈旁路移植術后新發房顫的處理經驗.中國醫藥指南, 2012, 10(7):171.
3.	Nucifora G, Schuijf JD, van Werkhoven JM, et al. Relationship between obstructive coronary artery disease and abnormal stress testing in patients with paroxysmal or persistent atrial fibrillation. Int J Cardiovasc Imaging, 2011, 27(6):777-785.
4.	孟旭, 王堅剛.心內直視下射頻消融術治療心房纖顫.中華胸心血管外科雜志, 2005, 21(4):247-248.
5.	Pokushalov E, Romanov A, Corbucci G, et al. Benefit of ablation of first diagnosed paroxysmal atrial fibrillation during coronary artery bypass grafting:a pilot study. Eur J Cardiothorac Surg, 2012, 41(3):556-560.
6.	宋士秋, 張健群, 李溫斌, 等.升主動脈隔離裝置在升主動脈近端鈣化患者非體外循環冠狀動脈旁路移植術中的應用.中國胸心血管外科臨床雜志, 2010, 17(2):158-160.
7.	劉健, 黃擊修, 林小彬, 等.不中斷冠脈循環下直視雙極射頻消融治療心房顫動.中國胸心血管外科臨床雜志, 2010, 17(5):425-427.
8.	劉勇, 繆文強, 魏旎, 等.心臟手術同期Atricure雙極射頻消融治療心房纖顫.廣東醫學, 2012, 33(21):3263-3264.
9.	趙強, 孫曉寧, 陳安清, 等.微創冠狀動脈旁路移植術同時行雙極消融治療房顫.中國臨床醫學, 2008, 15(2):139-141.
10.	羅勇, 張力, 陳劍, 等.非體外循環下冠狀動脈旁路移植術同期Atricure雙極射頻消融治療冠心病合并心房顫動七例報道.中華臨床醫師雜志:電子版, 2012, 6(4):1049-1050.
11.	Kalavrouziotis D, Buth KJ, Vyas T, et al. Preoperative atrial fibrillation decreases event-free survival following cardiac surgery. Eur J Cardiothorac Surg, 2009, 36(2):293-299.
12.	Khargi K, Lemke B, Haardt H, et al. Concomitant anti-arrhythmic surgery, using irrigated cooled-tip radiofrequency ablation, to treat permanent atrial fibrillation in CABG patients:expansion of the indication? Eur J Cardiothorac Surg, 2004, 25(6):1018-1024.
13.	Gammie JS, Haddad M, Milford-Beland S, et al. Atrial fibrillation correction surgery:lessons from the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg, 2008, 85(3):909-914.
14.	FukharaK, Kotoh K, DoiT, et al. Impact of preoperative atrialfibrillation on the late outcome of off-pump coronary artery bypass surgery. Eur J Cadiothorac Surg, 2010, 38(3):366-372.
15.	Ad N, Henry L, Hunt S, et al. Do we increase the operative risk by adding the Cox Maze Ⅲ procedure to aortic valve replacement and coronary artery bypass surgery? J Thorac Cardiovasc Surg, 2012, 143(4):936-944.
16.	Ad N, Henry L, Friehling T, et al. Minimally invasive standalone cox-maze procedure for patients with nonparoxysmal atrial fibrillation. Ann Thorac Surg, 2013, 96(3):792-798.
17.	Sueda T, Nagata H, Shikata H, et al. Simple left atrial procedure for chronic atriaI fibrillation associated with mitraI valve disease. Ann Thorac Surg, 1996, 62(6):1796-1800.
18.	Ad N, Suri R M, Gammie JS, et al. Surgical ablation of atrial fibrillation trends and outcomes in North America. J Thorac Cardiovasc Surg, 2012, 144(5):1051-1060.
19.	張大國, 劉秀倫, 劉小斌, 等.瓣膜置換術中直視雙極射頻消融治療風濕性心臟病心房纖顫70例.中華胸心血管外科雜志, 2011, 27(3):180-181.
20.	李軍山, 郭志剛, 宋靜華, 等. 22例冠狀動脈旁路移植術同期雙極射頻消融治療心房纖顫.中華臨床醫師雜志(電子版), 2012, 6(4):1049-1050.
21.	Henry L, Ad N. Performance of the Cox Maze procedure-a large surgical ablation center's experience. Ann Cardiothorac Surg, 2014, 3(1):62-69.
22.	于洋, 顧承雄, 李京倖, 等.非體外循環下采用自制二尖瓣成形裝置手術治療輕至中度缺血性二尖瓣關閉不全.中國胸心血管外科臨床雜志, 2012, 19(3):244-247.
23.	Hwang C, Chen PS. Ligament of marshall:why it is important for atrial fibrillation ablation. Heart Rhythm, 2009, 6(12 Suppl):S35-S40.
24.	閆倩, 劉興鵬, 李暉, 等.消融犬Marshall韌帶對刺激心房左后脂肪墊所致心房顫動的影響及機制.中國心臟起搏與心電生理雜志, 2010, 24(1):48-52.
25.	譚海斌, 楊希立, 溫旭濤.心房顫動經導管射頻消融治療發生的并發癥及處理.中國心臟起搏與心電生理雜志, 2008, 22(5):451-453.
26.	Benussi S, Galanti A, Nascimbene S, et al. Complete right atrial ablation with bipolar radiofrequency. Ann Thorac Surg, 2009, 87(5):1573-1576.

1. Pradhan R, Chaudhary A, Donato AA. Predictive accuracy of ST depression during rapid atrial fibrillation on the presence of obstructive coronary artery disease. Am J Emerg Med, 2012, 30(7):1042-1047.
2. 范萌, 李光日, 魏鋒.不停跳下冠狀動脈旁路移植術后新發房顫的處理經驗.中國醫藥指南, 2012, 10(7):171.
3. Nucifora G, Schuijf JD, van Werkhoven JM, et al. Relationship between obstructive coronary artery disease and abnormal stress testing in patients with paroxysmal or persistent atrial fibrillation. Int J Cardiovasc Imaging, 2011, 27(6):777-785.
4. 孟旭, 王堅剛.心內直視下射頻消融術治療心房纖顫.中華胸心血管外科雜志, 2005, 21(4):247-248.
5. Pokushalov E, Romanov A, Corbucci G, et al. Benefit of ablation of first diagnosed paroxysmal atrial fibrillation during coronary artery bypass grafting:a pilot study. Eur J Cardiothorac Surg, 2012, 41(3):556-560.
6. 宋士秋, 張健群, 李溫斌, 等.升主動脈隔離裝置在升主動脈近端鈣化患者非體外循環冠狀動脈旁路移植術中的應用.中國胸心血管外科臨床雜志, 2010, 17(2):158-160.
7. 劉健, 黃擊修, 林小彬, 等.不中斷冠脈循環下直視雙極射頻消融治療心房顫動.中國胸心血管外科臨床雜志, 2010, 17(5):425-427.
8. 劉勇, 繆文強, 魏旎, 等.心臟手術同期Atricure雙極射頻消融治療心房纖顫.廣東醫學, 2012, 33(21):3263-3264.
9. 趙強, 孫曉寧, 陳安清, 等.微創冠狀動脈旁路移植術同時行雙極消融治療房顫.中國臨床醫學, 2008, 15(2):139-141.
10. 羅勇, 張力, 陳劍, 等.非體外循環下冠狀動脈旁路移植術同期Atricure雙極射頻消融治療冠心病合并心房顫動七例報道.中華臨床醫師雜志:電子版, 2012, 6(4):1049-1050.
11. Kalavrouziotis D, Buth KJ, Vyas T, et al. Preoperative atrial fibrillation decreases event-free survival following cardiac surgery. Eur J Cardiothorac Surg, 2009, 36(2):293-299.
12. Khargi K, Lemke B, Haardt H, et al. Concomitant anti-arrhythmic surgery, using irrigated cooled-tip radiofrequency ablation, to treat permanent atrial fibrillation in CABG patients:expansion of the indication? Eur J Cardiothorac Surg, 2004, 25(6):1018-1024.
13. Gammie JS, Haddad M, Milford-Beland S, et al. Atrial fibrillation correction surgery:lessons from the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg, 2008, 85(3):909-914.
14. FukharaK, Kotoh K, DoiT, et al. Impact of preoperative atrialfibrillation on the late outcome of off-pump coronary artery bypass surgery. Eur J Cadiothorac Surg, 2010, 38(3):366-372.
15. Ad N, Henry L, Hunt S, et al. Do we increase the operative risk by adding the Cox Maze Ⅲ procedure to aortic valve replacement and coronary artery bypass surgery? J Thorac Cardiovasc Surg, 2012, 143(4):936-944.
16. Ad N, Henry L, Friehling T, et al. Minimally invasive standalone cox-maze procedure for patients with nonparoxysmal atrial fibrillation. Ann Thorac Surg, 2013, 96(3):792-798.
17. Sueda T, Nagata H, Shikata H, et al. Simple left atrial procedure for chronic atriaI fibrillation associated with mitraI valve disease. Ann Thorac Surg, 1996, 62(6):1796-1800.
18. Ad N, Suri R M, Gammie JS, et al. Surgical ablation of atrial fibrillation trends and outcomes in North America. J Thorac Cardiovasc Surg, 2012, 144(5):1051-1060.
19. 張大國, 劉秀倫, 劉小斌, 等.瓣膜置換術中直視雙極射頻消融治療風濕性心臟病心房纖顫70例.中華胸心血管外科雜志, 2011, 27(3):180-181.
20. 李軍山, 郭志剛, 宋靜華, 等. 22例冠狀動脈旁路移植術同期雙極射頻消融治療心房纖顫.中華臨床醫師雜志(電子版), 2012, 6(4):1049-1050.
21. Henry L, Ad N. Performance of the Cox Maze procedure-a large surgical ablation center's experience. Ann Cardiothorac Surg, 2014, 3(1):62-69.
22. 于洋, 顧承雄, 李京倖, 等.非體外循環下采用自制二尖瓣成形裝置手術治療輕至中度缺血性二尖瓣關閉不全.中國胸心血管外科臨床雜志, 2012, 19(3):244-247.
23. Hwang C, Chen PS. Ligament of marshall:why it is important for atrial fibrillation ablation. Heart Rhythm, 2009, 6(12 Suppl):S35-S40.
24. 閆倩, 劉興鵬, 李暉, 等.消融犬Marshall韌帶對刺激心房左后脂肪墊所致心房顫動的影響及機制.中國心臟起搏與心電生理雜志, 2010, 24(1):48-52.
25. 譚海斌, 楊希立, 溫旭濤.心房顫動經導管射頻消融治療發生的并發癥及處理.中國心臟起搏與心電生理雜志, 2008, 22(5):451-453.
26. Benussi S, Galanti A, Nascimbene S, et al. Complete right atrial ablation with bipolar radiofrequency. Ann Thorac Surg, 2009, 87(5):1573-1576.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Combined Off-pump Coronary Artery Bypass Grafting and Bipolar Radiofrequency Ablation for Atrial Fibrillation

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