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Concomitant Atrial Fibrillation in Patients with Mitral Valve Defects

Concomitant Atrial Fibrillation in Patients with Mitral Valve Defects

Yambatrov А.G., Medvedev А.P.
Key words: mitral valve; heart defect; atrial fibrillation; sinus rhythm; radiofrequency ablation.
2013, volume 5, issue 3, page 100.

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The current state of the problem of concomitant atrial fibrillation (AF) in patients with mitral valve defects was considered. The data on the epidemiology of mitral valve disease and the etiology and pathogenesis of atrial fibrillation were presented. The characteristics of the development of the heart rhythm disorder in patients with mitral valve disease and the possibilities of heart rhythm recovery after the valve surgery were showed. The probability of spontaneous recovery of sinus rhythm in these patients was found to be low especially in patients with persistent AF requiring concomitant interventions.

The history of the development of surgical techniques of atrial fibrillation management was reviewed. Now, a classic operation “Cox-Maze III” considered to be the “gold standard”, has commonly been displaced by alternative technologies replacing a scalpel. The data on the modern devices for surgical ablation (cryoablation, microwave, ultrasound ablation) were presented. Currently, the most common method is the radiofrequency ablation (RFA) consisting in the use of AC current of 50 kHz to 1 mHz. There were reviewed the properties of the method, its varieties, advantages and limitations. Initially used monopolar ablation was shown to have relatively low efficiency and the higher probability of complications than bipolar ablation that came into use later. “Cox-Maze IV” operation using bipolar RFA demonstrates the efficiency comparable to the classical “Maze III”. Despite certain advances in the surgical treatment of atrial fibrillation, the question of developing an optimal method able to be widely implemented with maximum efficiency and minimal complications was concluded to remain still open.


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