Predictive Value Of Preoperative Neutrophil-lymphocyte Ratio In Recurrence Of Atrial Fibrillation After Radiofrequency Ablation

Objective:To investigate the predictive value of preoperative neutrophil to lymphocyte ratio(NLR)for recurrence of atrial fibrillation(AF)patients after radiofrequency catheter ablation(RFCA).Methods:A total of 129 AF patients were selected from January 1,2014 to December 31,2015 in the Department of Cardiovascular Medicine,First Affiliated Hospital of Soochow University.The average age was(62.5±9.5)years old.Among them,84 were males(65.1%),101 were paroxysmal atrial fibrillation(PAF)(78.3%)and 28 were persistent atrial fibrillation(PeAF)(21.7%).The average follow-up period was(15.4±4.4)months.According to the follow-up results,the patients were divided into recurrence group and non-recurrence group.The basic clinical data between the two groups were compared.The risk factors affecting recurrence of atrial fibrillation after operation were analyzed.The risk factors affecting recurrence after RFCA were corrected by Multivariate Cox regression analysis,and the effect of NLR on recurrence of atrial fibrillation after operation was evaluated.The effect of different levels of NLR on recurrence of atrial fibrillation after operation was compared by introducing NLR into regression analysis with quartiles.The recurrence rate of atrial fibrillation after operation was compared by Kaplan-Meier survival analysis(Log-Rank test)according to levels of NLR.The predictive value of NLR for recurrence of atrial fibrillation after operation was evaluated by Receiver Operating Characteristic(ROC).Results:1.The proportion of women and persistent atrial fibrillation in recurrence group was higher than that in non-recurrence group(P<0.05),and the left atrial diameter increased significantly[(44±6)mm vs.(41+±5)mm,P=0.002],and the level of NLR was higher[(2.5 ± 1.2)vs.(1.8 ± 0.7),P=0.001].There were no differences in age,hypertension,diabetes,blood sugar,low density lipoprotein,high density lipoprotein,uric acid,mean platelet volume,platelet pressure,left ventricular end-diastolic diameter,left ventricular ejection fraction(P>0.05).2.After a follow-up of(15.4±4.4)months,40 cases(31.0%)relapsed,including 25 cases of paroxysmal atrial fibrillation(24.8%)and 15 cases of persistent atrial fibrillation(53.6%).The difference was statistically significant(P=0.004).Grouped by quartiles of NLR,the recurrence rates from low to high were 5(15.6%),8(24.2%),9(28.1%)and 18(56.3%)respectively,with significant differences(P=0.003).3.Multivariate Cox analysis showed that women(P=0.019),persistent atrial fibrillation(P=0.001),leftatrial diameter(P=0.001)and NLR(P=0.005)were independent risk factors for postoperative recurrence of atrial fibrillation.In order to further evaluate the effect of NLR level onpostoperative recurrence of atrial fibrillation.,we introduced NLR into regression analysis by quartiles,and concluded that high level of NLR(>2.36)would increase the postoperative recurrence of atrial fibrillation[HR=3.917,95%Cl(1.363-11.257),P=0.011].4.Kaplan-Meier survival curve showed that there were significant differences in the effect of different levels of NLR on postoperative recurrence of atrial fibrillation(Log-Rank:P=0.002).The ROC curve was used to estimate the predictive value of NLR for postoperative recurrence of AF.The AUC of all AF patients was 0.701(95%CI:0.597-0.805,P<0.001),and the AUC of patients with paroxysmal atrial fibrillation was 0.675(95%CI:0.543-0.806,P=0.009),AUC was 0.80(95%CI:0.625-0.975,P=0.007)in patients with persistent atrial fibrillation.Conclusions:1.Preoperative high NLR level is associated with recurrence of atrial fibrillation after radiofrequency ablation.The level of NLR is an independent risk factor for postoperative recurrence of atrial fibrillation.2.NLR has good predictive value for postoperative recurrence of atrial fibrillation,whether paroxysmal or persistent atrial fibrillation.