Predictive Value Of Red Blood Cell Distribution Width In The Occurrence And Ablation Success Of Atrial Fibrillation

Chapter 1: The effect of red blood cell distribution width on the occurrence of atrial fibrillationObjective:This study aims to explore the correlation between red blood cell distribution width（RDW）and atrial fibrillation,in order to provide auxiliary diagnostic indexes for the diagnosis of atrial fibrillation.Methods:A total of 500 patients with atrial fibrillation in the Department of Cardiology of our hospital from January 2020 to June 2021 were selected as the atrial fibrillation group,and 500 patients with sinus rhythm in the same period were selected as the control group.All the patients were divided into three groups by the types of atrial fibrillation:286 patients in paroxysmal atrial fibrillation group,187 patients in persistent atrial fibrillation group and 27 patients in permanent atrial fibrillation group.The basic data,laboratory indexes and echocardiographic indexes of all selected patients were collected.The differences of indexes between atrial fibrillation group and control group were compared,and the predictive value of relevant indexes on the occurrence of atrial fibrillation was analyzed by logistic regression and receiver operating characteristic（ROC）curve;The differences of RDW levels in different types of atrial fibrillation were analyzed.Finally,we analyzed the relationship between RDW and LAD.Results:（1）AF group and control group:There was statistically significant difference in stroke/TIA/thromboembolism history,Mean corpuscular volume（MCV）,RDW,Mean corpuscular hemoglobin concentration（MCHC）,Neutrophil lymphocyte ratio（NLR）,Platelet volume distribution width（PDW）,C-reactive protein（CRP）,Homocysteine（HCY）,Uric acid（UA）,Creatinine（Cr）,LAD,Left ventricular ejection fraction（LVEF）between the two groups（P<0.05）.（2）Logistic regression analysis showed that:MCV,RDW and LAD were independent risk factors of atrial fibrillation;ROC curve showed that:the area under the curve of MCV,RDW and LAD are 0.577,0.712 and 0.816 respectively.The best cutoff point of RDW was 12.25%,with sensitivity of 86.2%and specificity of 58.4%.（3）Different types of atrial fibrillation:There were significant differences in age,body mass index（BMI）,congestive heart failure/left ventricular dysfunction,stroke/TIA/thromboembolism history,RDW,UA,Cr,LAD and LVEF among the three groups（P<0.05）;RDW and LAD were different between paroxysmal atrial fibrillation and non-paroxysmal atrial fibrillation（P<0.05）.RDW was positively correlated with LAD（r=0.152,P=0.001）.Conclusion:The increase of RDW level is related to the occurrence of atrial fibrillation and it is different in paroxysmal atrial fibrillation and non-paroxysmal atrial fibrillation,which has a certain predictive value for the occurrence of atrial fibrillation.Chapter 2: Predictive value of red blood cell distribution width for successful atrial fibrillation ablationObjective:This study aims to to analyze the value of RDW level and its changes predicting the success of atrial fibrillation ablation.Methods:Patients have done atrial fibrillation ablation in the Department of Cardiology of our hospital from January 2019 to December 2020 were selected as the research objects（the ablation methods include cryoablation and radiofrequency ablation）.Initially 200 cases were included,7 cases were excluded through the inclusion and exclusion criteria,and finally 193 subjects were included,including 79 patients undergoing radiofrequency ablation and 114 patients undergoing cryoablation.The basic data,medication,laboratory indexes（including reexamination indexes within 3 months）and echocardiographic indexes of all selected patients were collected,and the recurrence and related examinations were followed up at 3,6,9 and 12 months.According to the median RDW,they were divided into low RDW group and high RDW group.According to whether there was recurrence,they were divided into recurrence group and non recurrence group.The differences of indicators between different groups were compared.Univariate and multivariate Cox regression models were used to analyze the influencing factors of atrial fibrillation recurrence,and ROC curve was used to evaluate its value.Finally,Kaplan-Meier curve was used to analyze the influence of relevant factors on the recurrence of atrial fibrillation after ablation.Results:（1）Median grouping of RDW:There were significant differences in ablation mode（Cryoablation/Radiofrequency）,use of Angiotensin converting enzyme inhibitor（ACEI）,Hemoglobin（HGB）,MCHC,LAD and LVEF between the between low RDW group and high RDW group（P<0.05）.（2）Groups according to recurrence:The differences in LAD and ΔRDW was statistically significant between recurrence group and non recurrence group（P<0.05）.（3）Cox regression analysis:ΔRDW（HR:0.435,95%CI:0.285-0.663,P<0.001）and LAD（HR:1.096,95%CI:1.030-1.165,P=0.004）were independent predictors of recurrence after ablation of atrial fibrillation.（4）ROC curve:The area under the curve of ΔRDW is 0.764,which has a certain predictive value for the non recurrence（successful ablation）of atrial fibrillation after ablation.The best cut off point is 0.25%,the sensitivity is 66.0%,and the specificity is 78.4%.（5）Kaplan-Meier curve:the recurrence rate after ablation in the ΔRDW≥0.25%group was lower than that in the ΔRDW<0.25%group.The result of log rank test showed that P<0.001.There was significant difference between the two groups.The P values of log rank test for different ablation methods and types of atrial fibrillation were 0.979 and 0.102,The difference was not statistically significant.Conclusion:There was no significant difference in ablation success rate between different ablation methods and different types of atrial fibrillation;The reduction of RDW after atrial fibrillation ablation has a certain predictive value for the success of atrial fibrillation ablation.