| This study consists of two parts.The first part discusses whether there is any difference between high-power short-duration(HPSD)and low-power long-duration(LPLD)radiofrequency ablation in the treatment of non-valvular atrial fibrillation(NVAF)in the elderly.The second part discusses whether there is any difference in the complication rate and recurrence rate of atrial fibrillation between the elderly and the non-elderly NVAF patients,who have undergone HPSD radiofrequency ablation.In order to evaluate the effectiveness and safety of HPSD radiofrequency ablation in the elderly NVAF patients.Part One Clinical observation between high-power short-duration and lowpower long-duration radiofrequency ablation in the treatment of atrial fibrillation in the elderly.Background:Atrial fibrillation is a common disease in the elderly,which is easy to induce heart failure and thromboembolism,and seriously reduces the quality of life of the elderly patients.Radiofrequency catheter ablation(RFCA)is one of the main methods for the treatment of NVAF patients,but conventional RFCA still has some problems,such as long time,high risk of complications related to excessive ablation and so on.The HPSD radiofrequency ablation,proposed in recent years,has been confirmed by many clinical trials and studies at home and abroad,which can significantly shorten the ablation time and operation time,reduce the recurrence rate of atrial fibrillation and do not increase the incidence of complications.This study intends to explore the difference between HPSD and LPLD in the treatment of NVAF in the elderly.Purpose:To compare the difference between HPSD and LPLD in the treatment of NVAF in the elderly.Methods:A total of 100 patients aged≥65 years with atrial fibrillation who underwent RFC A in our hospital from January 2019 to June 2020 were collected,including 40 patients in the HPSD group and 60 patients in the LPLD group.The basic condition,operation and complications of the two groups were collected and compared.The patients were followed up regularly after operation,recurrence of atrial arrhythmia,cardiac function(NT-pro BNP,LVEF,LAD)and adverse events were collected.We analyze and compare the difference between HPSD and LPLD in the treatment of NVAF in the elderly,and explore the risk factors of recurrence after RFCA in the elderly patients with NVAF.Results:The operation time in the HPSD group was significantly shorter than that in the LPLD group(141.05±39.33min vs 186.08±47.57min,P<0.001),and the recurrent rate of atrial fibrillation in the HPSD group was lower than that in the LPLD group(10.0%vs 22.3%,P=0.089).The incidence of complications(all complications:10.0%vs 16.7%,P=0.347;main complications:2.5%vs 8.3%,P=0.397)and the incidence of adverse events(2.5%vs 0.0%,P=0.400)of the two groups were similar.Cardiac function was improved in both groups after operation.The improvement in the HPSD group(NT-pro BNP:556.99±777.66pg/ml vs 958.22±1122.85pg/ml,P=0.022;LAD:44.55±7.74mm vs 45.00±8.03mm,P=0.130;LVEF:65.24±4.00%vs 61.17±6.81%,P=0.005)was slightly better than that in the LPLD group(NT-pro BNP:753.41±928.43pg/ml vs 1201.82±1497.68pg/ml,P=0.004;LAD:44.53±67.23mm vs 45.74±6.97mm,P=0.070;LVEF:62.30±6.05%vs 61.55±6.83%,P=0.145).After RFC A,the cardiac function was significantly improved in the non-recurrence group(NT-pro BNP:532.15±669.43pg/ml vs 1073.86±1323.58pg/ml,P=0.001;LAD:42.60±6.34mm vs 45.11±7.31mm,P=0.001;LVEF:64.32±4.23%vs 61.20±6.82%,P=0.001),but there was no significant change in the recurrence group.Non-paroxysmal atrial fibrillation(OR:3.862,95%CI:1.162-12.841,P=0.028)and blanking period of atrial fibrillation(OR:9.153,95%CI:2.185-38.345,P=0.002)were the independent risk factors for recurrence after RFC A in the elderly patients with NVAF.Conclusion:(1)The operation time in the HPSD group was significantly shorter than that in the LPLD group,and the recurrent rate of atrial fibrillation in the HPSD group was lower than that in the LPLD group.There is no difference in the incidence of complications and adverse events between the two groups.(2)After RFC A,the cardiac function in the HPSD group and the LPLD group were improved,and the cardiac function in the non-recurrence group was significantly improved,while there was no significant change in the recurrence group.(3)Non-paroxy smal atrial fibrillation and blanking period of atrial fibrillation were the independent risk factors for recurrence after RFC A in the elderly patients with NVAF.Part Two Comparative analysis of high-power short-duration radiofrequency ablation in the treatment of atrial fibrillation between the elderly and the non-elderlyBackground:Compared with the young patients,the elderly patients are characterized by many complicated diseases,hypercoagulable state and decreased drug metabolism,which lead to poor therapeutic effect and poor surgical tolerance.HPSD radiofrequency ablation is one of the measures for the treatment of NVAF in recent years.This study explores whether there is any difference in the incidence of complications and the recurrence rate of atrial fibrillation between the elderly and the non-elderly patients,who have undergone HPSD radiofrequency ablation.Purpose:To evaluate the difference of HPSD in the treatment of NVAF between the elderly and the non-elderly patients.Methods:The patients who underwent HPSD radiofrequency ablation for atrial fibrillation in our hospital from January 2019 to June 2020 were collected.According to the inclusion and exclusion criteria,99 patients were included,including 40 elderly patients and 59 non-elderly patients.The basic condition,operation and complications of the two groups were collected and compared.The patients were followed up regularly after operation,recurrence of atrial arrhythmia,cardiac function(NT-pro BNP,LVEF,LAD)and adverse events were collected.We analyze the efficacy and safety of HPSD radiofrequency ablation in the treatment of NVAF in the elderly patients.Results:The average CHA2DS2-VASc score(4.38±1.63 vs 2.03±1.14,P<0.001)and HASBLED score(2.05±0.78 vs 0.69±0.82,P<0.001)of the elderly group were significantly higher than those of the non-elderly group.After adjusting for age,the average CHA2DS2-VASc score(3.03±1.48 vs 2.03±1.14,P=0.001)and HAS-BLED score(1.05±0.78 vs 0.69±0.82,P=0.016)of the elderly group were still significantly higher than those of the non-elderly group.The serum albumin in the elderly group was significantly lower than that in the non-elderly group(41.38±3.77g/L vs 43.25±3.78g/L,P=0.017).The prevalence rates of hypertension(65.0%vs 42.4%,P=0.027)and coronary heart disease(25.0%vs 10.2%,P=0.049)in the elderly group were higher than those in the non-elderly group.There was no difference in the success rate of operation(89.8%vs 90.0%),the incidence of complications(10.0%vs 10.2%)and the incidence of adverse events(2.5%vs 1.7%)between the elderly group and the nonelderly group.In the elderly group,the level of NT-pro BNP decreased after ablation(556.99±777.66pg/ml vs 958.22±1122.85pg/ml,P=0.022),the LVEF significantly increased after ablation(65.24±4.00%vs 61.17±6.81%,P=0.02),while the LAD was similar to that before operation(P=0.130).The LAD of the non-elderly group was smaller after ablation(41.55±8.23mm vs 43.39±7.05mm,P=0.021),and there was no significant difference in the LVEF and NT-pro BNP after ablation(P=0.808 and P=0.071).Covariance analysis showed that after HPSD radiofrequency ablation,the LVEF of the elderly group was higher than that of the non-elderly group(P=0.003).Conclusion:(1)HPSD radiofrequency ablation is effective and safe in the elderly patients aged≥65 years old.There is no difference in the recurrence rate of atrial fibrillation,the incidence of complications and the incidence of adverse events between the two groups.(2)In addition to the differences in age,there were also significant differences in the baseline data such as clinical complications,CHA2DS2-VASc score and HAS-BLED score between the elderly group and the non-elderly group.(3)After HPSD radiofrequency ablation,the improvement of cardiac function in the elderly group was slightly better than that in the non-elderly group,the LVEF of the elderly group increased significantly. |
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