Analysis Of Risk Factors Related To The Recurrence Of Atrial Fibrillation After Second Generation Cryoballoon Ablation

Objective: Atrial fibrillation(AF)is one type of atrial arrhythmias with a high incidence.Cryoballoon ablation has been widely used in the treatment of atrial fibrillation(AF),and the relevant research results have been reported in a few domestic centers.However,the risk factors related to postoperative recurrence,especially the data from a long term follow up,are scarcely reported.At the present study,the recurrence and the related risk factors were analyzed in patients with AF underwent a second generation cryoballoon ablation in our center.Methods: From August of 2016 to December of 2018,the patients with AF who were treated by a second generation cryoballoon ablation were included in this study,and the recurrence,recurrence time,postoperative medications and body weight change were followed up by telephone and/or outpatient follow-up.The first 3 months after cryoballoon ablation were a window of blank period,during which AF attack was not considered as a recurrence.The patients were divided into different groups based on the date of the procedure and the date of recurrence.The differences of the risk factors related to AF recurrence in each group were explored,and the risk factors were analyzed for predictive value analysis and survival analysis.The use of antihypertensive drugs in the hypertension subgroup was analyzed,and the recurrence in patients using angiotensin converting enzyme inhibitor(ACEI)/ angiotensin receptor blocker(ARB)as antihypertensive drugs was compared with that without using.Results: Seven hundreds and sixty patients were treated with the second generation cryoballoon ablation in our center,among whom 748 of the 760 patient had a good follow-up,and only 12(1.58%)of whom lost in the follow-up.The recurrence rate at≥ 1 year postoperative,≥2 years postoperative and ≥3 years postoperative was 31.42%(235/748 patients),34.85%(130/373 patients)and 37.5%(30/80 patients),respectively.The new recurrence rate in the second year and the third year was 6.17%(23/373 patients)and 6.25%(5/80 patients),both of which were lower than that in the first year(25%,187/748 patients).The course of AF(P < 0.001),anteroposterior diameter of left atrium(P = 0.03)and the rate of body weight gain(P < 0.001)were the risk factors to predict AF recurrence,among which the course of AF(P < 0.001)and the rate of body weight gain(P < 0.001)were the independent risk factors in the first year.The course of disease(< 0.001)and the rate of body weight gain(< 0.001)were the independent risk factors in the second year.The course of disease(P =0.02)and the rate of weight change(P=0.047)were the independent risk factors in the third year.The boundary point of the ROC curve of combined prediction of the course of AF attack and the rate of body weight gain is 24.5 months and 1.46% respectively.And the ability of joint prediction is greater than that of single prediction.According to the analysis of patients in hypertension subgroup,although there was no significant difference between baseline data,the recurrence rate(25.84%)of patients using ACEI / ARB as antihypertensive drugs was lower than that of patients using other antihypertensive drugs(39.84%)(P = 0.01).Conclusion: Of 748 patients underwent the second generation cryoballoon ablation,the recurrence rate at≥1 year postoperative,≥2 years postoperative and ≥3 years postoperative was 31.42%,34.85% and 37.5%,respectively.The new recurrence rate in the second year and the third year was 6.17% and 6.25%,both of which were lower than that in the first year(25%).The anteroposterior diameter of left atrium is the risk factor of AF recurrence in the first year after operation.The duration of AF and the rate of body weight gain were the independent risk factors for recurrence in the first,second and third year after operation.The course of disease and the rate of body weight gain have the ability to predict the recurrence,the boundary point is 24.5 months and 1.46% respectively,and the combined prediction ability is greater than the single prediction.In the hypertension subgroup,the recurrence of AF in patients treated with ACEI / ARB as antihypertensive drugs was lower than that in patients treated with other antihypertensive drugs.