[Safety and efficacy of Cox-maze Ⅲ procedure for patients with atrial fibrillation associated with rheumatic mitral valve disease]

OBJECTIVE

To evaluate the safety and efficacy of cut-and-sew Cox-Maze (CM) Ⅲ procedure for patients with atrial fibrillation associated with rheumatic mitral valve disease.

METHODS

Patients received mitral valve replacement and CM procedure between January 2007 and July 2015, were 1∶1 matched and assigned to CM Ⅳ group (undergoing surgical ablation) and CM Ⅲ group (undergoing cut-and-sew CM Ⅲ). Safety indices, mortality rate, complications and recovery rate of sinus rhythm were compared between the two groups.

RESULTS

Mean extracorporeal circulation time was (154±22) min in the CM Ⅲ group and (136±21) min in the CM Ⅳ group (P<0.001), and aortic clamp time was (85±9) min in the CM Ⅲ group and (74±12) min in the CM Ⅳ group (P<0.001). One patient (1.18%) in the CM Ⅲ group died of multi-organ failure 4 day after left ventricular rupture being sucessfully repaired, and 2 patients died (2.35%) in the CM Ⅳ group ( 1 due to left ventricular rupture and 1 due to low cardiac output syndrome). There was no significant difference in mortality between the two groups. Temporary pacemaker were applied for 76 cases (89.41%) in the CM Ⅲ and 70 cases (82.35%) in the CM Ⅳ group, without a statistical difference (P=0.186). There were also no statistical difference between the two groups in intraoperative urinary volume, postoperative drainage of fluid volume, hemoglobinuria, ventilator time, ICU time, hospital stay and the incidence of the complications (all P>0.05). Sinus rhythm recovery rate was 62.35 % in the CM Ⅲ group and 57.65 % in the CM Ⅳ group, without a statistical difference (P=0.531) at the operation day, but at discharge a statistical difference was found (97.62% in the CM Ⅲ group vs 81.93% in the CM Ⅳ group, P<0.001). All patients were followed up for three months, and no deaths occurred. Sinus rhythm recovery rate was 96.43 % in the CM Ⅲ group and 86.75% in the CM Ⅳ group, with a statistical difference (P=0.024).

CONCLUSION

The cut-and-sew Cox-Maze Ⅲ procedure is a safe and effective method for patients with atrial fibrillation associated with rheumatic mitral valve disease.

KCNE1 112G>a polymorphism and atrial fibrillation risk: a meta-analysis

KCNE1, a membrane protein that spans the membrane once is responsible for modulating potassium channel functions and plays an important role in the etiology of arrhythmia. Emerging evidence indicates that a common polymorphism (112G>A; rs1805127 G>A) in the KCNE1 gene contributes to atrial fibrillation (AF) risk; however, these studies showed inconclusive results. In this meta-analysis, we derived a more precise estimation of the association between the KCNE1 112G>A polymorphism and AF risk. The following databases were searched: Web of Science (1945-2013), the Cochrane Library Database (Issue 12, 2013), PubMed (1966-2013), EMBASE (1980-2013), CINAHL (1982-2013), and the Chinese Biomedical Database (1982-2013). The crude odds ratios with their 95% confidence intervals were calculated. Nine case-control studies were included, with a total of 1792 AF patients and 1924 healthy controls. The meta-analysis results indicated that the KCNE1 112G variant is associated with an increased risk of AF. Further subgroup analysis based on ethnicity revealed significant associations between the KCNE1 112G variant and an increased risk of AF among both Asians and Caucasians. No publication bias was detected in this meta-analysis. In conclusion, our results indicate that the KCNE1 112G polymorphism may be a risk factor for AF. KCNE1 112G>A may be useful as a biomarker for predicting the development of AF.