| Objective:Combined with transthoracic echocardiography and transesophageal echocardiography,using parameters of left atrial structure and function,left atrial appendage structure and function,left ventricular filling pressure,right ventricular function,etc,to evaluate the prognosis of patients with persistent atrial fibrillation treated by transcatheter radiofrequency ablation,and to assist clinical departments in identifying high-risk groups prone to recurrence after radiofrequency ablation,so as to formulate appropriate treatment strategies and improve the success rate of radiofrequency ablation.Methods:From January 2017 to March 2018,52 patients with persistent atrial fibrillation who were hospitalized in the Department of Cardiology of Tianjin First Central Hospital and received radiofrequency catheter ablation for the first time were enrolled in this subjects.Patients with atrial tachycardia,atrial flutter or atrial fibrillation lasting more than 30 seconds during the period from 3 months to 12months after radiofrequency ablation were classified as relapse group,a total of 22patients,and the remaining 30 successful patients were classified as control group.The left atrial structure and function,left atrial appendage structure and function,left ventricular function and right ventricular function parameters were measured by transthoracic echocardiography and transesophageal echocardiography before operation.The electrophysiological examination and circumferential pulmonary vein isolation was performed under the guidance of fluoroscopy and CARTO three-dimensional modeling.The end point of ablation was confirmed to be successful pulmonary vein-atrium isolation by LASSO electrode mapping.Electrophysiological stimulation did not induce atrial fibrillation.Follow-up visits were made at 3,6 and 12 months after the operation to investigate the recurrence of AF.In addition,patients with palpitation or irregular pulse at any time after the operation are required to see a doctor immediately so as to record the electrocardiogram in time.SPSS 17.0 statistical software was used for data analysis.Continuous variables were expressed as"Average±standard deviation"(x?s).Independent sample t test was used for comparison between the two groups;categorized variables were expressed as"rate"(%).And the two groups were compared by?~2 test.Bivariate logistic regression analysis was used to analyze the independent predictors of recurrence in patients with persistent atrial fibrillation after radiofrequency ablation.P<0.05 showed significant difference with statistical significance.Results:1.There was no significant difference in general data between the relapse group and the control group(P>0.05).2.Left atrium:Compared with the control group,LAD,LAVmax and LAVmin increased in the relapsed group,while LAEF decreased,and the difference was statistically significant(P<0.05).3.Left atrial appendage:Compared with the control group,LAAVmin increased,LAAEF decreased,and LAAEV and LAAFV also decreased in the relapsed group,with statistical significance(P<0.05).4.Left ventricular:Compared with the control group,the e’in the relapsed group decreased,and the E/e’increased,indicating that the left ventricular filling pressure increased.5.Right heart:Compared with the control group,TAPSE decreased,TRV and PAP increased in the relapsed group.6.Bivariate Logistic regression analysis showed that LAAEF was an independent risk factor for recurrence after radiofrequency ablation in patients with persistent atrial fibrillation.Conclusion:1.Echocardiographic risk factors can be used to screen patients with persistent atrial fibrillation who are prone to recurrence after transcatheter radiofrequency ablation,so as to formulate a reasonable treatment plans and improve the success rate of surgery.It is recommended to combine multiple indicators for preoperative screening.2.The risk of atrial fibrillation recurrence increases with the increase of left atrium and left atrial appendage volume and the decrease of evacuation fraction.3.With the decrease of blood flow velocity in left atrial appendage,the risk of atrial fibrillation recurrence increases.4.Preoperative assessment should include left ventricular filling pressure,and be alert to recurrence when left ventricular filling pressure increases.5.Right ventricular function also has certain predictive value for the recurrence of atrial fibrillation after operation.6.Transesophageal echocardiography is indispensable before radiofrequency ablation.Left atrial appendage emptying function can be used as an independent predictor of recurrence in patients with persistent atrial fibrillation after radiofrequency catheter ablation.7.The changes of left atrial appendage in patients with atrial fibrillation may be earlier than that of left atrium,and the changes of function may be earlier than that of structure.8.Even in patients with persistent atrial fibrillation,the earlier radiofrequency ablation is performed,the better the prognosis. |
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