| PART ONE:Risk factors of general information for postoperative recurrence of second generation cryoballoon ablation in patients with paroxysmal atrial fibrillationObjective: Atrial fibrillation(AF)is one of common cardiac arrhythmia.And the incidence of atrial fibrillation increases with the age.This retrospective study aimed to analyze the risk factors for postoperative atrial fibrillation(AF)recurrence in paroxysmal AF patients who underwent second generation cryoballoon catheter ablation.we recorded AF that recurred since 3 months after cryoballoon catheter ablation.Methods: We selected a total of 98 patients with paroxysmal AF who were treated with second generation cryoballoon balloon catheter ablation in Tianjin Chest Hospital from October in 2016 to May in 2017.All the patients were followed up 1 month,3 months,6 months,9 months and one year after the cryoballoon balloon catheter ablation.According to whether the AF recurred during postoperative follow-up(starting from 3 months after surgery),the patients were divided into AF recurrence group and sinus rhythm maintenance group.The basic data of the two groups were compared: age,gender,prevalence rate of hypertension,prevalence rate of diabetes,prevalence rate of coronary heart disease,duration of atrial fibrillation,history of smoking and history of drinking;Cardiac ultrasound indexes: left atrial diastolic diameter(LA),left ventricular diastolic diameter(LV),left ventricular ejection fraction(EF);Blood test indexes:Serum potassium ion concentration(K),urea nitrogen(BUN),creatinine(Cre),uric acid(UA),serum albumin(propagated),alanine aminotransferase(ALT),aspartate aminotransferase(AST),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),hypersensitive c-reactive protein(CRP),b-type brain natriuretic peptide precursor(BNP),troponin(Tn T),thrombolysis dimers(D-Dimmer),white blood cell count(WBC),hemoglobin(Hb),platelet count(PLT),thyroid stimulating hormone(TSH)et al.performed statistical analysis of risk factors for recurrence of atrial fibrillation in patients.Results:Of the 98 cases of paroxysmal atrial fibrillation included in this study,17 cases were recurrent atrial fibrillation and 81 cases were maintained by sinus rhythm.Univariate analysis showed that there was significant difference between two groups in the incidence of coronary heart disease,the level of hypersensitive C-reactive protein,pro-B-type natriuretic peptide precursor and the duration of AF(all p < 0.05).Multivariate logistic regression analysis identified hypersensitive C-reactive protein,type B natriuretic peptide and AF duration as the factors influencing the recurrence of AF(p < 0.05).Conclusion: The concentration of hypersensitive hs C-reactive protein,pro B-type natriuretic peptide and the duration of AF are independent risk factors for postoperative AF recurrence in paroxysmal AF patients who undergo cryoballoon catheter ablation.PART TWO The correlation between the P wave duration indexes and postoperative recurrence of second generation cryoballoon ablation in patients with paroxysmal atrial fibrillationObjective: In this part of the study,P wave duration indexes were collected under the sinus rhythm in patients with standard synchronous 12 lead ECG,which including maximum P wave duration Pmax,minimum P wave duration of Pmin,and P wave dispersion Pd.This retrospective study aimed to analyze the correlation between the P wave duration indexes and postoperative recurrence of second generation cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation since 3 months after cryoballoon catheter ablation.Methods: We selected a total of 98 patients with paroxysmal AF who were treated with cryoballoon balloon catheter ablation in Tianjin Chest Hospital from October in 2016 to May in 2017.All the patients were followed up the first month,third month,sixth month,,ninth month and first year after the cryoballoon balloon catheter ablation.According to whether the AF recurred during postoperative follow-up(starting from 3 months after surgery),the patients were divided into AF recurrence group and sinus rhythm maintenance group.The ECG of standard synchronous 12 lead ECG with sinus rhythm were collected on four time intervals—pre-operation,post-operation 1 month,post-operation 3 months,and post-operation 6 months.P wave duration(maximum P wave duration,minimum P wave duration,and P wave dispersion)were calculated by Nholter V1.1.0.5 software to analyze the correlation between P wave duration indexes and the recurrence of postoperative atrial fibrillation.Results: Of the 98 cases of paroxysmal atrial fibrillation included in this study,17 cases were recurrent atrial fibrillation and 81 cases were maintained by sinus rhythm.The results of univariate statistical analysis showed that there was no statistically significant difference of P wave duration of sinus cardiogram among the four time intervals groups.There was no significant difference in the minimum P wave duration(Pmin)between the af recurrence group and sinus rhythm maintenance group in all the four time intervals groups.Pmax and Pd in the recurrence group of atrial fibrillation were longer than those in the maintenance group(P<0.01).Therefore,univariate analysis showed that preoperative Pmax and Pd were correlated with recurrence of atrial fibrillation after second-generation cryoballoon catheter ablation.Multiple Logistic regression analysis results showed that both Pmax and Pd were the influencing factors for the recurrence of atrial fibrillation after cryoballoon ablation(all P values were less than 0.05,of which the P value of Pd was< 0.01).ROC curve analysis of Pmax and Pd to predict recurrence of atrial fibrillation after cryoballoon catheter ablation(AUC)was 0.766 and 0.918,respectively,both of which were statistically significant(P<0.01).The results showed that the Pmax yoden index was 0.5178,the optimal diagnostic threshold was 118 ms,the predictive sensitivity was 76.47%,specificity was 75.31%,the Pd yoden index was 0.7712,the optimal diagnostic threshold was 42 ms,the predictive sensitivity was 88.24%,and the specificity was 88.89%.With Pmax ≥118ms and Pd≥ 42 ms as the diagnostic threshold,atrial fibrillation recurrence after cryoballoon catheter ablation as the prediction event,the results showed that the misdiagnosis rate of atrial fibrillation recurrence predicted by Pmax ≥118ms was 25.92%,and the rate of missed diagnosis =41.18%.The rate of misdiagnosis of atrial fibrillation recurrence predicted by Pd ≥ 42 ms was 2.5%,and the rate of missed diagnosis was 34.78%.Considering kaplan-meier survival analysis,the results showed that the probability of recurrence free from atrial fibrillation(that is,the probability of maintaining the sinus rhythm)was significantly higher in Pmax <118ms and Pd <42ms(Log Rank P<0.001).Conclusion: The results of this part of study suggest that the recurrence of atrial fibrillation in patients with paroxysmal atrial fibrillation after second-generation cryoballoon catheter ablation(post-operation 3 months)is associated with the maximum P wave duration(Pmax)and P wave dispersion(Pd)of standard 12-lead ECG under preoperative sinus rhythm.When estimating the recurrence of patients with paroxysmal af who undergo the second generation cryoballoon catheter ablation,it is necessary to consider Pmax and Pd.In addition,Pmax of 118 ms and Pd of 42 ms can be used as the diagnostic threshold for the P wave duration for the recurrence of atrial fibrillation after the cryogenic balloon ablation.Both of them have predictive value,and Pd has greater value in predicting the recurrence of atrial fibrillation. |
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