| Objectives:This study aims to analyze the relationship between the scar of circumferential pulmonary vein and recurrence rate after catheter ablation in patients with atrial fibrillation using late gadolinium enhancement cardiac magnetic resonance imaging(LGE-c MRI),to compare the efficacy of the single-step cryoballoon ablation with the point-by-point radiofrequency current ablation,and to explore the relationship between the scar of circumferential pulmonary vein and post-ablation recurrence.Methods:A total of 60 patients with nonvalvular atrial fibrillation who underwent catheter ablation from July 2014 to December 2016 in Fujian Provincial Hospital were enrolled in this study.Among them,30 patients underwent radiofrequency ablation(RFA),and the other 30 cases underwent cryoballoon ablation(CBA).All patients were diagnosed as atrial fibrillation by electrocardiogram,the clinical data were collected pre-ablation(age,history of atrial fibrillation,biochemical indicators,echocardiography,transesophageal echocardiography,electrocardiogram,left atrium and pulmonary vein computed tomography angiography,etc.),excluding surgical contraindications.All patients underwent late gadolinium enhancement cardiac magnetic resonance imaging at 3 months after ablation,and assessed the scar of circumferential pulmonary vein in left atrial.In the RFA group 1 case was excluded due to gadolinium allergy,and the other 2 patients refused LGE-cMRI.One case was excluded from the CBA group due to loss of association.All patients were monitored by telephone or outpatient follow-up(patients complained,ECG or 24-hour Holter,etc.)after 6 months.Recurrent atrial tachyarrhythmias(ATa)were defined as AF,atrial flutter,or atrial tachycardia,and duration ? 30 seconds.Results: Follow up was performed in 56 patients,and 13 patients experienced late recurrence,43 cases of patients maintained sinus rhythm.The recurrence rate was 23.21%.The scarring ratio of circumferential pulmonary vein in recurrence group was lower than that in the non recurrent group by LGE-cMRI((63.25±5.86)% VS(79.95±7.47)%),and there was significant difference(P <0.001).Univariate analysis shows that the recurrence rate(24.14% VS 22.22%,P =0.865),the total scarring ratio of circumferential pulmonary vein((74.54±10.30)% VS(77.03±10.03)%,P=0.364)and the scarring ratio in recurrence group((62.84±6.07)% VS(63.96±6.15)%,P=0.806)were no significant differences between the CBA group and the RFA group.Therefore,it can not be considered that the efficacy of cryoballoon ablation and radiofrequency ablation is different.The scarring ratio of each pulmonary vein in 56 patients was as follows,the left superior pulmonary vein(76.80±11.80)%,the left inferior pulmonary vein(78.90±10.64)%,the right superior pulmonary vein(83.35±9.44)%,the right inferior pulmonary vein(66.13±13.44)%.Statistical analysis showed that the right inferior pulmonary vein was significantly different from the other three pulmonary veins(P <0.05),considered that the lower right pulmonary vein scar was significantly lower than the other three.And there was a significant difference between the left superior pulmonary vein and the right superior pulmonary vein(P < 0.05).The remaining differences were not statistically significant.Conclusions:1.patients with atrial fibrillation after catheter ablation of circumferential pulmonary vein scar is lower,the recurrence rate is higher.2.The circumferential pulmonary veins scar after cryoablation and radiofrequency catheter ablation is equivalent,and the pulmonary vein isolation effect of the two surgical methods is comparable.3.The scar in the right inferior pulmonary vein and the left superior pulmonary vein is less,which may be related to the site of the special anatomy and the Unstable catheter position at the time of ablation. |
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