| BackgroundAtrial fibrillation(AF)is the most common persistent supraventricular arrhythmia.With the development of interventional therapy,catheter ablation or cryoballoon ablation has become the best treatment option for symptomatic atrial fibrillation.However,there are still many problems with recurrence.Many studies have reported that the success rate of ablation in patients with paroxysmal atrial fibrillation is about 70%,while that in patients with persistent atrial fibrillation is only 50%,which means that the recurrence rate of single ablation is between 30% and 50%.In fact,the high success rate of catheter ablation in acute cases is currently considered achievable,but its lasting efficacy remains a major challenge.Therefore,it is of great significance to identify the recurrence of atrial fibrillation early and we may take some measures to reduce the disability rate and fatality rate caused by stroke.Considering the predictors of atrial fibrillation recurrence after ablation,the selection of patients suitable for radiofrequency ablation has become an important issue to achieve better results.Many studies have shown that different clinical and subclinical factors,including elderly,female,classical cardiovascular risk factors,non-paroxysmal atrial fibrillation,left ventricular dysfunction,myocardial fibrosis and atrial enlargement have been identified as possible predictors of recurrence after ablation.At present,the main mechanism of paroxysmal atrial fibrillation is ectopic beats originating in the pulmonary veins.Therefore,pulmonary vein isolation(PVI)has become the main ablation method for patients with paroxysmal atrial fibrillation.Clinical studies have shown that various arrhythmias,including atrial fibrillation,atrial flutter,atrial tachycardia and atrial premature beats are prone to occur after radiofrequency catheter ablation(RFCA).Among them,atrial premature beat is the most common,and the mechanism is unclear.So far,the relationship between early atrial premature beats and late recurrence after ablation of atrial fibrillation has not been reported at home and abroad,so further studies are still needed to confirm.ObjectiveAnalyze the risk factors of atrial fibrillation recurrence after ablation,research the relationship between early atrial premature beats burden and atrial fibrillation recurrence after ablation,and the predictive value of these risk factors for atrial fibrillation recurrence.MethodsWe retrospectively searched the baseline informations and examinations for the 98 patients with paroxysm atrial fibrillation who underwent radiofrequency ablation in our department between January 2017 to December 2017.HOLTER was performed on all the selected patients the second day after radiofrequency ablation,and the burden of atrial premature beats were calculated.The patients were followed up for 12 months after operation.The end point of the study was the recurrence of atrial fibrillation.Comparing the difference of early atrial premature beat burden between recurrence group,and ROC curve was drawn to find out the cut-off of early APB burden that could predict the recurrence of atrial fibrillation.Compare the difference of baseline data,laboratory examination,echocardiography parameters,atrial CT parameters and other related indicators between the two groups.Logistic regression analysis of single and multi-factor were further performed for the indicators with statistical significance.Resuls(1)The comparison of baseline data and clinical examination results between the relapsed group and the non-relapsed group showed that the patients in the relapsed group had lower baseline HDL cholesterol and higher baseline free thyroxine(FT4)levels than those in the non-relapsed group,and the differences were statistically significant(P < 0.05).(2)The HOLTER results showed that the immediate APBs in the recurrent group was higher than that in the non-recurrent group(1327(169-5508)VS.221(38-1287).The difference was statistically significant(P < 0.05).(3)The ROC curve analysis showed that the best value for predicting the recurrence of AF was when atrial premature burden ≥ 816/day.The area under the curve was 0.697(95% CI 0.562-0.831,P=0.008),and the sensitivity and specificity were 68.4% and 70.9% respectively.(4)Univariate logistic regression analysis showed that the APBs≥ 816/day and high-normal FT4 were positively correlated with the late recurrence after radiofrequency ablation for patients with paroxysmal atrial fibrillation.While levels of HDL-C was not associated with the recurrence.(5)Multivariate logistic regression analysis showed that high-normal FT4 and APBs≥ 816/day after AF ablation both were independent risk factors for AF late recurrence.(6)The ROC curve showed that the area under curve of APBs≥816/day to predict late recurrence of paroxysmal atrial fibrillation after radiofrequency ablation was 0.697(95%CI: 0.562-0.831,P<0.05,while the area under curve of APBs≥816/day combined with high-normal FT4 was 0.762(95%CI: 0.648-0.876,P<0.001).However,there was no significant difference between the areas under curve(P=0.136).ConclusionsEarly APBs≥816/day after radiofrequency ablation and high-normal FT4 levels are independent risk factors for late recurrence of paroxysmal atrial fibrillation after radiofrequency ablation.And the early APBs≥816/day has good predictive value for late recurrence of paroxysmal atrial fibrillation. |
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