| Background and purposeAtrial fibrillation(AF)is one of the most common arrhythmia.It is disabling and has a high fatality rate.With the development of surgical techniques for radio-frequency ablation,AF catheter ablation was recommended as Ia in the2016AHA/ACC/HRS guidelines.It has been reported that pulmonary vein is the main trigger of most AF patients.For symptomatic refractory AF patients,pulmonary vein isolation catheter ablation has become the main method,which is very effective for paroxysms or persistent AF However,since the AF mechanism is not very clear,there are recurrences after catheter ablation,and the risk of these recurrences is difficult to predict.In previous studies,12-lead electrocardiogram or 24 h Holter was often used to evaluate the postoperative recurrence of AF.The monitoring time was relatively short and the follow-up time varied.In this study,135 patients with the first catheter radio-frequency ablation of AF were collected and analyzed.The patients were followed up for 1 year,and their recurrence was observed by 24 h Holter and 10-day Holter.The predictive value of clinical variables for recurrence was also discussed.MethodsIn this study,135 clinical data of AF patients undergoing radio-frequency ablation were collected and analyzed.At 1 year follow-up,79 cases(58.5%)were males and 56 cases(41.5%)were females.There were 84 cases of paroxysmal AF(62.2%)and 51 cases of persistent AF(37.8%).Average age(62.61 ± 10.27)years;The recurrence rate and the recurrence of paroxysms and persistent AF were observed by using 24 h Holter and 10 d Holter.The two groups were divided into the recurrence group and the non-recurrence group,and the predictors of postoperative AF recurrence were further studied.SPSS 21.0 was used for statistical analysis,and p<0.05 was taken as the difference was statistically significant.Results24h Holter recorded 108 AF patients without recurrence and 27 with recurrence,with a recurrence rate of 20%.10 d Holter recorded 101 AF patients without recurrence,34 with recurrence rate of 25.2%.The results of AF recurrence detected by 10 d Holter and 24 h Holter were generally consistent(kappa=0.726,p< 0.001),and the recurrence assessed by 10 d Holter after radio-frequency ablation of AF catheter was higher thanthat of 24 h Holter,but the difference was not significant(p=0.092).After 10 d Holter,19 patients experienced recurrence of paroxysmal AF,with a recurrence rate of22.6%(19/84),and 15 patients experienced recurrence of persistent AF,with a recurrence rate of 29.4%(15/51).After 24 h Holter,15 patients suffered recurrence of paroxysmal AF,with a recurrence rate of 17.9%(15/84),and 12 patients suffered recurrence of persistent AF,with a recurrence rate of 23.5%(12/51).The recurrence rate of persistent AF was higher than that of paroxysmal AF group 1 year after operation(c2 =1.447,p=0.229),but the difference was not significant.Combined with the analysis of the two results,Thirty-seven patients with AF recurred one year after operation,with a recurrence rate of 27.4%.In the analysis of clinical baseline data,it was found that the recurrence variables affecting AF after radio-frequency ablation were AF course(42.68±41.19,p=0.025),preoperative heart rate(80.32±19.25,p=0.021),and QT interval(375.84±44.31,p=0.033),with statistically significant differences(p< 0.05).Multivariate logistic regression analysis of AF course,heart rate,QT interval,double atrial size and AF type was included,and the duration of AF course,right atrial diameter and heart rate were found to be independent risk factors for AF recurrence after operation.(OR=0.986(0.976,0.996),p=0.006;OR=0.918(0.847,0.995),p=0.037;OR=1.020(1.003,1.038),p=0.018).ConclusionCompared with 24 h Holter,10 d Holter was more sensitive to recurrence assessment 1 year after radio-frequency ablation of AF catheter.The recurrence rate of persistent AF 1 year after operation was higher than that of paroxysmal AF group as assessed by 10 d Holter.Duration,heart rate and right atrial diameter were independent factors for AF recurrence after operation. |
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