Predictive Value Of Cystatin C And Left Atrial Volume Index For Early Recurrence After Catheter Ablation Of Patients With Atrial Fibrillation

Objective:The aim is to evaluate the predictive value of cystatin C and left atrial volume index(LAVI)for early recurrence(ER)after catheter ablation in patients with atrial fibrillation(AF).Methods:54 patients with non-valvular atrial fibrillation who underwent radiofrequency catheter ablation of atrial fibrillation in the First Affiliated Hospital of Guangxi Medical University from March 2017 to March 2018 were selected for analysis.32 patients with paroxysmal atrial fibrillation(23 males and 9 females),22 patients with persistent atrial fibrillation(18 males and 4females).All patients underwent circumferential pulmonary vein ablation under the guidance of Carto three-dimensional mapping system.For paroxysmal atrial fibrillation Circumferential pulmonary vein ablation was successfully performed in patients with atrial fibrillation,and the end point of ablation was bilateral electrical isolation of left and right pulmonary veins.For patients with persistent atrial fibrillation,circumferential pulmonary vein ablation was performed first,and linear ablation of left atrial top and anterior was performed when necessary.After successful bidirectional electrical isolation of left and right pulmonary veins was detected,if atrial fibrillation rhythm remained after the above-mentioned ablation,the cardioversion or ibutilide cardioversion was given.All patients without contraindication were given rivaroxaban or dabigatran anticoagulant and amiodarone antiarrhythmia for 3 months.All patients were examined by blood routine,renal function,blood lipid and transthoracic echocardiography before operation.The patients were followed up for 3 months after the catheter radiofrequency ablation,and according to the symptoms and electrocardiogram results and other indicators within 3 months,there was no atrial fibrillation,atrial flutter or atrial tachycardia.Recurrence of atrial fibrillation was defined as atrial fibrillation/atrial flutter/atrial velocity that occurred within 3 months after surgery for a duration of 30s.Paroxysmal atrial fibrillation is defined as atrial fibrillation that terminates spontaneously or with intervention within 7 days after onset,and persistent atrial fibrillation is defined as atrial fibrillation that lasts longer than 7 days.Results:(1)A total of 54 patients with atrial fibrillation underwent catheter radiofrequency ablation.All patients completed circumferential pulmonary vein isolation.32 patients with paroxysmal atrial fibrillation and 22 patients with persistent atrial fibrillation were divided into paroxysmal atrial fibrillation group and persistent atrial fibrillation group.There were no significant differences in age,gender,body mass index(BMI),accompanying conditions(such as hypertension,diabetes,smoking and alcohol consumption)between the two groups,while there were statistically significant differences in cystatin C,neutrophil to lymphocyte ratio(NLR),left atrial diameter,left atrial volume index,left ventricular end systolic diameter and ejection fraction.(2)Among 54patients with atrial fibrillation,there were 14 cases of the recurrence in 3 months after catheter radiofrequency ablation,which paroxysmal atrial fibrillation recurred in 5 cases and persistent atrial fibrillation recurred in 9 cases.They were divided into recurrence group and non-recurrence group.Univariate analysis showed that age,duration of atrial fibrillation,cystatin C,neutrophil to lymphocyte ratio(NLR),left atrial diameter and left atrial volume index in the recurrence group were higher than those in the non-recurrence group,and the prpportion of persistent atrial fibrillation in the recurrence group(64.3%)was higher than that in non-recurrence group(32.5%)(P<0.05).Multivariate analysis showed that preoperative cystatin C level and preoperative left atrial volume index in the recurrence group were both higher than those in the non-recurrence group(P<0.05).(3)Cystatin C and left atrial volume index were used to predict the recurrence of atrial fibrillation.The area under the ROC curve of cystatin C was 0.844 and cystatin C was more than 1.115mg/l.The sensitivity and specificity of predicting early recurrence of atrial fibrillation were 0.643 and0.875.The area under the ROC curve of left atrial volume index before operation was 0.804 and the left atrial volume index was more than 49.425ml/m~2.The sensitivity and specificity of predicting early recurrence of atrial fibrillation were 0.786 and 0.825.Conclusions:Preoperative cystatin C level and left atrial volume index are predictors of early recurrence after radiofrequency ablation of atrial fibrillation.