Prediction Of The Recurrence Of Atrial Fibrillation After Catheter Ablation With Mild To Moderate Mitral Valve Insufficiency

BackgroundAtrial fibrillation(AF),as one of the common clinical arrhythmias,causes great living and economic burden on patients with its high recurrence rate and high risk of stroke and heart failure.In recent years,with the maturity of percutaneous catheter cardiac radiofrequency ablation technology,radiofrequency ablation has become one of the important means of treating AF,but there are still some patients with AF recurrence after radiofrequency ablation,and how to reduce the recurrence rate has become a new problem to be solved in clinical practice.Mitral regurgitation(MR)leads to left atrial remodeling,which affects sinus rhythm maintenance after AF radiofrequency ablation.Previous clinical studies have shown that severe mitral regurgitation is related to the recurrence of AF after surgery,but whether mild and moderate mitral regurgitation can also predict the recurrence of AF after radiofrequency is still lacking.MethodsA total of 221 AF patients without severe MR Who received AF radiofrequency ablation for the first time in China-Japan Friendship Hospital of Jilin University from January 2017 to July 2021 were retrospectively included.Patients were divided into MR Group and control group according to Mitral regurgitation area(MRA).Three months after radiofrequency ablation,atrial arrhythmias(AF,atrial tachycardia,atrial flutter)exceeding 30 s confirmed by electrocardiogram or 24-hour holter electrocardiogram were used as the standard definition of postoperative recurrence.The patients were followed up for(29.8±13.7)months to confirm the recurrence of the patients after surgery.Body mass index(BMI),gender,age,left atrial dimension(LAD),MRA and other data of the two groups were collected to compare the postoperative recurrence rate between the two groups.Then,MRA was used as a continuous variable to analyze whether MRA was a risk factor for recurrence after radiofrequency ablation.ResultThe recurrence rate of AF after radiofrequency ablation was significantly higher in the MR Group than in the control group(31.6% vs 17.3%,P=0.014).Further risk factor analysis using MRA as a continuous variable showed that patients in the recurrence group had higher preoperative MRA and LAD values than those in the non-recurrence group,with statistical significance(P<0.05).COX regression analysis showed that MRA was an independent risk factor for recurrence after AF catheter ablation(HR 1.217,95%CI:1.024-1.445,P=0.004).In the receiver operating curve(ROC),the AUC of LAD was 0.608(P=0.016,95%CI: 0.527-0.690),and the optimal cut-off value was 38.15(sensitivity 83.6%,specificity 57.9%).The AUC value of MRA was 0.604(P=0.021,95%CI: 0.518-0.689),and the optimal cut-off value was0.50(sensitivity 67.3%,specificity 47.6%).ConclusionAmong patients undergoing AF radiofrequency ablation for the first time,those with mild to moderate MR Had a higher likelihood of postoperative recurrence than those without significant mitral regurgitation.The patients with postoperative AF recurrence had higher LAD and MRA values than those without AF recurrence.Higher preoperative MRA was an independent predictor of recurrence after radiofrequency ablation.