Correlative Study On Relationship Between Pulmonary Vein Diameter And Left Atrial Diameter And Recurrences Of Atrial Fibrillation After Catheter Ablation

Objectives: The Aim of this study was to investigate the predictors of recurrent AF after RFCA.To analyze the relationship between pulmonary vein diameter and left atrial diameter andrecurrences of atrial fibrillation after catheter ablation.Methods:156patients who hospitalized in the Uygur Autonomous Region People’s Hospital ofXinjiang, Department of Cardiology, from August2010to October2013were included in thisstudy. The information includes age, sexuality, accompanied disease, course of disease andmedicine used before ablation, modus operandi, imaging diagnosis such as pulmonary veincomputed tomography and echocardiography.156patients (56.43±10.59years,97male) withparoxysmal, persistent and permanent atrial fibrillation (AF) undergoing catheter ablation.According to the American Heart Association/American Heart AS sociation/European Society ofCardiology (ACC/AHA/ESC)2011guide lines issued for treatment of atrial fibrillation, allpatients who were defined as medical records including electrocardiogram (ECG) and HolterECGs. All patients included40patients (25.6%) had hypertension,27patients (17.3%) hadcoronary heart disease,12patients (7.7%) had diabetes;115patients (73.7%)with paroxysmal AF;25patients （16.0%),16patients（10.3%）. Successfully radiofrequency ablation was performedin all patients. Multi-slice Spiral computed tomography (MSCT) and Echocardiography wereperformed in all patients before the radiofrequency catheter ablation (RFCA). First to evaluate thepulmonary vein (PV) anatomy, then to measure the diameters of PVs ostia.Recording the left atrialdiameter (LAD). The shape of ostia was determined,the venous ostium index(VOI) was calculatedfor all veins by dividing anterior-posterior measurements by superior-inferior measurements.Transesophageal echocardiography was performed to exclude the thrombus in the left atrialappendage and left atrial. After the Radiofrequency catheter ablation (RFCA) were completed, allpatients underwent follow-up at every month and to inspection include Twelve-leadelectrocardiographic study,24-hours Holter monitoring, and echocardiographic examination. Allpatients were claimed to record the intensive questioning regarding any arrhythmia relatedsymptoms. Recurrence of as defined as recurrence of atrial tachyarrythmias (ATs), including AF,atrial flutter and atrial tachycardia (AT). All patients were followed at least3months. Until theending of follow-up,108patients (69.2%) with no atrial arrhythmia symptom which was assignedto no-recurrence group.48patients (30.8%) who had Atrial arrhythmias recurrence,including11cases(22.9%)with atrial flutter,4cases（8.3%）with Atrial tachycardia,33cases（68.8%) with AF.48patients were assigned to recurrence group.Results were compared between the2groups.Statistical analysis was performed with SPSS.Results: Among the156study patients,The mean of anterior-posterior diameter of left superiorpulmonary vein(LSPV), left inferior pulmonary vein(LIPV), right superior pulmonaryvein(RSPV), right inferior pulmonary vein(RIPV) were13.91±2.97mm,12.58±2.34mm,16.22± 2.73mm,16.25±2.67mm; The mean of superior-inferior diameter of LSPV, LIPV, RSPV, RIPVwere18.31±2.68mm,16.66±2.50mm,19.03±2.49mm、18.71±2.10mm. Among the variables ofgender, age, height, weight, the body mass index(BMI), the body surface area (BSA), whether AFwas paroxysmal, persistent or permanent, whether had diabetes and coronary heart disease has nostatistically significant difference between the two groups. The diameter of LSPV, LIPV and RSPV,the duration of AF, The history of hypertension，LAD and LVEF which has statisticallysignificant difference in recurrence group. The multivariate analysis shows that the increase of thediameter of LSPV and RSPV, the duration of AF,LAD and LVEF were independent variablepredictive of the occurrence of AF. The venous ostium index (VOI) was calculated which meansthat the ostia of RSPV and RIPV were more round than LSPV and LIPV. The venous ostium ofRSPV and RIPV is approximate to the round shape.The venous ostium of LSPV and LIPV isapproximate to oval.Conclusion: This study shows that:1The increase of the diameters of LSPV and RSPV,theduration of AF,LAD and LVEF are the potential significant complication of the recurrences ofRFCA.2The shape of PVs are significant difference.