Radiofrequency Ablation Of Persistent Atrial Fibrillation And One-Stop Treatment Of Left Atrial Appendage Occlusion Combined With Radiofrequency Ablation

Objective:Atrial fibrillation is the most common type of tachyarrhythmia,stroke is the most serious complication of it.The treatment of atrial fibrillation mainly involves the prevention of thromboembolism and the control of rhythm and ventricular rate.In this study,the safety and effectiveness of radiofrequency ablation and one-stop Treatment of left atrial appendage occlusion combined with radiofrequency ablation in patients with persistent atrial fibrillation were analyzed,and provided a reference for doctors in the treatment of atrial fibrillation.Methods:Patients with persistent atrial fibrillation admitted to the 404 Hospital of Mianyang,Sichuan Province from January 2018 to December 2019 were enrolled for first interventional surgical treatment,including radiofrequency ablation and one-stop treatment.During the operation,the doctor will check for abnormal potential except for the pulmonary vein according to the electrophysiological mapping system,and if there is,additional ablation will be performed.Additional left atrial appendage occlusion was performed in patients with a higher blood risk score and absolute or relative anti coagulation contraindications.The data of patients were collected,and analyzed by SPSS23.0 statistical software.The measurement data of stroke/thromboembolism,death,hemorrhage,postoperative recurrence and additional ablation were analyzed by chi-square to compare whether there was statistically significant difference between groups.Univariate logistic analysis and multivariate logistic analysis were employed to analyze the dangerous factors of postoperative recurrence of persistent atrial fibrillation.Results:A total of 84 patients were enrolled in this study,32 in the one-stop treatment group and 52 another.(1)There were no significant differences between the two groups in gender,age,LA(left atrial anterior and posterior diameter in echocardiography),LVEF(left ventricular ejection fraction),NT Pro-BNP,combined with heart failure,hypertension and coronary heart disease.The CHA2DS2-VASc score and HA-BLED score(P<0.05)were significantly higher than those in radiofrequency ablation group;In addition,the incidence of diabetes,stroke/TIA/thrombosis in the one-stop treatment treatment group was significantly higher than that in another group(P<0.05).LV(left ventricular end-diastolic diameter)was larger in the radiofrequency ablation group(P<0.05).(2)Chi-square test results indicated that stroke/thromboembolism,death,postoperative atrial arrhythmia recurrence and additional ablation between the two groups were no statistically differences(P>0.05),but there were statistically significant differences in bleeding events between the two groups(P<0.05).(3)Univariate logistic analysis prompted that LA was a risk factor for recurrence of persistent atrial fibrillation after individualized ablation(P<0.05).Multivariate logistic analysis prompted that LA had a significant effect on relapse after controlling other variables(P<0.05,OR=1.272).Conclusion:1.Pulmonary venous electrical isolation is still the cornerstone of radiofrequency ablation,but for patients with persistent atrial fibrillation,atrial stroma mapping is particularly important.High-density mapping can effectively guide stroma mapping in patients with persistent atrial fibrillation and guide radiofrequency ablation.2.LA is a risk factor for recurrence after radiofrequency ablation in who suffer from persistent atrial fibrillation,which can be used to guide the screening of patients with ablation of atrial fibrillation.3.The one-stop treatment of left atrial appendage occlusion combined with radiofrequency ablation is not inferior to radiofrequency ablation in the prevention of stroke/thromboembolism,but the one-stop treatment is more advantageous in terms of postoperative bleeding events.