Effect Of Catheter Radiofrequency Ablation On Inflammatory Factors And Left Ventricular Function In Patients With Atrial Fibrillation

Background:Atrial fibrillation(AF), the most commonly encountered arrhythmia in clinical practice, is associated with a 2-fold increase in toal and cardilvascular mortality,as well as the potential for substantial morbidity, including stroke, congestive heart failure, and cardiomyopathy.Its incidence and prevalence are increasing, and it represents a growing clinical and economic burden. All of the organizational structure and electrical characteristics of atrial factors can lead to atrial fibrillation. Their own treatment for atrial fibrillation, recent studies focus more on non-drug combination therapies and new methods of treatment, control around the rhythm, ventricular rate control and prevention of thromboembolism to expand, including radiofrequency ablation (RFA) has become widely accepted, in a treatment center experience, radiofrequency ablation has become the treatment of choice for atrial fibrillation. 2006 ACC/AHA/ESC guidelines were confirmed atrial fibrillation radiofrequency ablation for atrial fibrillation is an independent resort and second-line treatment of its reference position. Some scholars believe that in recent years, radiofrequency ablation can be used as first-line treatment of atrial fibrillation. Scholars in favor of the view that the drug treatment of atrial fibrillation is ineffective, and potentially dangerous; radiofrequency ablation of atrial fibrillation can remove disease in symptomatic patients, without the medications and may improve quality of life. However, some scholars have objected that the radiofrequency ablation as first-line treatment of atrial fibrillation insufficient evidence.It is recognized that the first cause of atrial fibrillation associated with inflammation of the heart surgery example is the simultaneous occurrence of high incidence of atrial fibrillation and high levels of inflammation. The current research evidence shows that more and more closely related to atrial fibrillation and inflammation. The research evidence, including the individual atrial fibrillation increased infiltration of inflammatory cells, increased expression of inflammatory factors, inflammation of blood inflammatory markers in patients were significantly higher, the use of a pleiotropic anti-inflammatory drugs (such as statins, ACEI/ARB class drugs and fish oil, etc.) and glucocorticoid therapy reduced the incidence of atrial fibrillation evidence. There are also some studies get different results, particularly in relation to study the relationship between AF and inflammation mostly cross-sectional study can only show a symbiotic relationship between the two, but can not explain how inflammation is the cause of atrial fibrillation, Therefore, AF is an inflammatory disease that view is still not as "atherosclerosis is essentially an inflammatory disease," so widely accepted.Mononuclear cells are activated to produce a series of cytokines, including interleukin -6 (IL-6), activation of inflammatory cells and vascular cells may secrete excessive proinflammatory cytokine IL-6, IL- 6 can stimulate the liver cells produce large amounts of CRP in a waterfall-like chain reaction amplification, induce or aggravate inflammation. CRP is a recognized marker of inflammatory diseases. Large-scale clinical studies have shown that patients with atrial fibrillation increased inflammatory markers. CRP levels in patients with atrial fibrillation are two times higher than non-AF patients, and CRP levels in patients with permanent atrial fibrillation are higher than that of paroxysmal atrial fibrillation. If atrial fibrillation is caused by inflammation, the level of inflammatory factors should decrease after restoration of sinus rhythm, whereas if the AF is the result of inflammation, the levels of inflammatory factors will not drop even if sinus rhythm restored.Objectives:1. the study sought to compare the effect of ventricular rate control of drug treatment and the radiofrequency catheter ablation of paroxysmal atrial fibrillation and persistent atrial fibrillation on left atrial diameter (LAD), left ventricular diameter (LVD), left ventricular ejection fraction (LVEF%) and cardiac function Classification (NYHA) and the changes of radiofrequency catheter ablation before and after treatment LAD, LVD, LVEF%, and NYHA.2. the study sought to compare the C-reactive protein (hs-CRP), interleukin-6 (IL-6) levels in patients with atrial fibrillation and sinus rhythm.Study hs-CRP, IL-6 levels in patients maintaining sinus rhythm and atrial fibrillation recurrence after ablation.Subjects:The first part of the study:Choose from January 2008 to May 2010 Nanfang Hospital, Southern Medical University hospital treatment of patients with chronic atrial fibrillation screening study in 83 patients,49 males and 34 females, aged 52.9±8.9 years. Paroxysmal atrial fibrillation in 43 cases,40 cases of persistent AF. AF duration of 19.7±13.0 months. Inclusion criteria:(1) without organic heart disease, paroxysmal atrial fibrillation and persistent atrial fibrillation, symptoms, and 1 or more than 1 anti-arrhythmic drug therapy poor; (2) 18<Age<75 years; (3) left atrial diameter<55mm; (4) left ventricular ejection fraction> 30%. Exclusion criteria:(1) uncontrolled atrial fibrillation with heart failure. (2) patients with atrial fibrillation have organic heart disease, such as valve disease, congenital heart disease, dilated or ischemic heart disease. (3) the esophageal Doppler ultrasound detected left atrial thrombus. (4) acute myocardial injury or systemic infection. (5) with severe lung function, liver function, kidney function impairment or other chronic diseases. (6) patients or their families refuse to catheter ablation or drug therapy.The second part of the study:AF:Select January 2008 to June 2010 Southern Medical University, Department of Cardiology, Nanfang Hospital, radiofrequency ablation for atrial fibrillation 62 patients (42 patients with paroxysmal atrial fibrillation,20 patients with persistent atrial fibrillation). AF group inclusion criteria: (1) The surface ECG or Holter monitoring confirmed as atrial fibrillation; (2) 18 <Age<75 years; (3) left atrial diameter<55mm; (4) transthoracic and transesophageal echocardiography, left atrial thrombus-free. Exclusion criteria were: (1) heart disease, valvular disease, congenital heart disease, decompensated heart failure; (2) malignant tumor, acute and chronic infection, hyperthyroidism, connective tissue disease, liver and kidney dysfunction and hypertension control bad; (3) within the past 3 months occurred in acute cardiovascular and cerebrovascular events and trauma and surgical procedures; (4) received immunosuppressive therapy and the presence of leukopenia disease.38 patients were male,24 cases of female patients, history of atrial fibrillation (20.15±14.53) months. Control group:Select the same hospital in the Department of Cardiology, Nanfang Hospital,62 patients with sinus rhythm, and atrial fibrillation group sex, age, body mass index, blood pressure, left ventricular function, hypertension, diabetes, drug use and other pairing. Exclusion criteria as above.Methods: The first part methods:83 patients with atrial fibrillation were randomly assigned to drug treatment group (control group) or radiofrequency ablation group (RF group). Treatment group 38 patients, mean age 53.2±8.9 years, radiofrequency ablation group of 45 patients, mean age 52.7±9.0 years. Drugs were given digoxin, (3 blockers and other medications to control ventricular rate at rest remained at 60 to 80 beats/min, mild exercise does not exceed 100 beats/min, oral international normalized ratio (INR) 2.0-3.0 anticoagulation therapy. RF group underwent radiofrequency ablation of pulmonary vein to give low molecular weight heparin 3d conventional warfarin therapy 2 to 3 months (maintenance INR2.0～3.0), amiodarone 0.2,3/day for 1 to 2 weeks after the cut amount to 0.2,2/day for 1 to 2 weeks, and finally to 0.2,1/day to maintain patient follow-up after 3 months. Two groups of patients before treatment and 3,6 after treatment follow-up were asked clinical symptom, checked ECG,24-hour ambulatory ECG and echocardiography to evaluate patients with LAD, LVD, LVEF%, NYHA. If patients in RF group recurrence of atrial fibrillation 3-month follow-up, they should take the second ablation.The second part methods:All subjects fasting peripheral venous blood collected in anticoagulant tubes 5 ml of ultra-high-speed centrifuge 10 min serum was separated, stored at -70°C freezer equipment seized. Catheter ablation patients had 6 months follow-up and peripheral venous blood samples were collected again, with the former method. Enzyme-linked immunosorbent assay of interleukin -6 (IL-6) concentrations, immune turbidimetric method of high sensitivity C-reactive protein (hs-CRP) concentrations.Results:1. success rate of paroxysmal atrial fibrillation and persistent atrial fibrillation single CPVA ablation was 75.5%, second CPVA ablation success rate was 86.6%.2. Compared RF group with control group before and 3 months,6 months after ablation left atrial diameter LAD (mm) were 46.2±5.4vs45.3±5.7mm; 43.3±4.6vs46.0±5.5mm; 39.7±3.3vs47.6±5.5m, there is a significant difference between the two groups (P= 0.003). After 3 months left atrial of RF group reduced and this change is more evident at 6 months.3. Compared the RF group with control group before and 3 months,6 months after ablation, left ventricular diameter LVD (mm) were 51.6±5.8vs50.8±5.4mm; 50.6±5.4vs51.4±5.1mm; 46.0±3.8vs53.1±5.2mm, the difference between the two groups was statistically (P= 0.033). After 3 months left ventricular of RF group narrowed and this change is more evident at 6 months.4. Compared the RF group with control group before and 3 months,6 months after ablation left ventricular ejection fraction LVEF (%) were 49.0±10.8%vs48.1±10.4%; 52.4±8.9%vs48.2±9.5%; 59.1±6.0%vs47.7±9.6%, there is a significant difference between the two groups (P= 0.005). After 3 months ejection fraction of RF group increased and this change is more evident 6 months.5. Compared the RF group with control group before and 6 months after ablation, NYHA functional class of RF group before ablation NYHAⅠ/Ⅱ/Ⅲwere 13/20/12, after 6 months NYHAⅠ/Ⅱ/Ⅲwere 36/7/2. The control group preoperative NYHAⅠ/Ⅱ/Ⅲwere 12/8/18, after 6 months NYHAⅠ/Ⅱ/Ⅲwere 3/16/19. There is a significant difference between the two groups (P<0.001). After 6 months heart function of RF group improved.6-Compared the RF group before and after 6 months LAD was 45.9±4.6mmvs39.8±3.1mm, LVD was 51.3±5.6mmvs45.7±3.6mm, LVEF was 48.9±10.2 (%)vs58.8±5.4 (%), NYHA classificationⅠ/Ⅱ/Ⅲwere 11/19/9vs34/5/0, there were significantly differences (P<0.001). Left atrial, left ventricular were narrowing, left ventricular ejection fraction, heart function were improved after ablation.7. The atrial fibrillation group compared with non-AF group hs-CRP, IL-6 levels were 2.11±0.66 vs 0.95±0.33mg/L; 12.94±2.19vs6.82±2.56pg/mL, there were significantly differences. (P<0.001).8. Compared persistent atrial fibrillation with paroxysmal atrial fibrillation, hs-CRP, IL-6 levels were 2.45±0.81vs 1.94±0.51; 14.22±2.16vs12.34±1.95, there were significantly differences (P values<0.05). Successful sub-group and the relapse subgroup hs-CRP, IL-6 levels were 1.85±0.47vs3.61±0.79mg/L; 10.7±1.7vs12.7±2.6pg/mL, there were significantly differences. (P<0.05).Conclusion:1. The circumferential pulmonary vein ablation of atrial fibrillation has a high success rate. Left atrial diameter, left ventricular diameter were narrowed and left ventricular ejection fraction, heart function were improved 3 months after ablation, this reversal was more evident 6 months later.2. The success of circumferential pulmonary vein radiofrequency ablation can reduce the inflammation.