Changes Of Left Atrial And Ventricular Structure And Function After Catheter Ablation Of Atrial Fibrillation And Its Effect On Postoperative Recurrence

Objective:To determine the changes of left atrial and ventricular structure and function before and after radiofrequency ablation and cryoballoon ablation in patients with atrial fibrillation(AF)and its effect on recurrence after catheter ablation of atrial fibrillation(AF).Methods: A total of 76 patients who underwent atrial fibrillation catheter ablation in our hospital from August 2016 to July 2018 were enrolled.Before operation,baseline data and transthoracic echocardiography data were collected for all patients,including:left atrial diameter(LAD),maximum left atrial volume(LAVmax),minimum left atrial volume(LAVmin),left atrial pre-systolic volume(LAVp),left ventricular end-systolic diameter(LVESD),Left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic volume(LVEDV),left ventricular end-diastolic volume(LVESD),velocity time integral of left ventricular outflow tract flow(LVOT-VTI),early diastolic peak velocity of mitral valve(E peak),Late diastolic peak velocity(peak A),early diastolic peak velocity(e ')on the side and side of mitral annulus interventricular septum,total atrial conduction time(PA-TDI)? Left ventricular ejection fraction(LVEF),left atrial ejection fraction(LAEF),left atrial function index(LAFI),E/ A,E/ e' were calculated.The above indicators were re-examined at the48-hour,1-month and 3-month follow-up visits.The differences in baseline data and postoperative follow-up of patients in RF ablation group and cryoballoon ablation group were compared.All patients were followed up after operation.,and patients were divided into recurrence group and non-recurrence group according to whether the recurrence occurred.The differences of the baseline data and the transthoracic echocardiography data during postoperative follow-up between recurrence group and non-recurrence group were compared.Multivariate logistic regression was used to analyze the independent risk factors for recurrence of atrial fibrillation.Results: 1.In patients undergoing radiofrequency ablation,LAVmax,LAVmin and LAVp were significantly decreased at 1 month and 3 months after operation compared with those before operation,and the differences were significant(P <0.05).In patients with zhen-onset AF,LAD decreased significantly at 1 month and 3 months afteroperation compared with that before operation,LAFI decreased significantly at 48 hours after operation,and gradually recovered at 1 month and 3 months after operation.E peak and interval e 'decreased significantly at postoperative 1 month,A peak decreased significantly at postoperative 48 h and postoperative 1 month,corresponding E/ A increased significantly at postoperative 48 h,and side wall e'decreased at postoperative 48 h.In patients with persistent AF,LAD decreased significantly at 3 months after operation,LAEF and LAFI increased significantly at 3months after operation,E peak decreased significantly at 3 months after operation,and A peak decreased significantly at 48 hours and 1 month after operation.LVESD decreased significantly 3 months after operation compared with that before operation,LVEDV increased significantly 48 hours after operation compared with that before operation,and the above differences had statistical significance(P <0.05).2.In patients receiving cryoballoon ablation,LAD,LAVmax,LAVmin and LAVp reflecting the left atrial structure and storage function were similar to those in radiofrequency ablation group.The mean changes of LAEF and LAFI reflecting left atrial contraction were transiently decreased after operation and recovered at 3 months after operation.In patients with paroxysmal atrial fibrillation,the interval e 'decreased at 48 h and 1 month after operation,and recovered at 3 months after operation.The differences were significant(P <0.05).The mean e 'value of the sidewall decreased and then increased after ablation,but only 48 h after the procedure was statistically significant(P = 0.008).LVEDV decreased significantly at 48 h and 1 month after operation compared with that before operation,and LVESD decreased significantly at3 months after operation(P <0.05).The peak A at 48 h after operation and the interval e'and LVESD at 1 month after operation in patients with persistent atrial fibrillation were significantly lower than those before operation.3.Early recurrence(P <0.001),paroxysmal atrial fibrillation(P = 0.007),baseline BNP level(P = 0.012),LVEDV 48 h after operation(P = 0.028)and LAEF level 1 month after operation(P = 0.048)were significantly different between the recurrent group and the non-recurrent group.Logistic regression showed that early recurrence and LVEDV at 48 h after operation were independent risk factors for postoperative recurrence of atrial fibrillation.Conclusion: 1.After radiofrequency ablation for atrial fibrillation,the patient hadreverse remodeling of left atrium,and the inner diameter and volume were significantly lower than those before the operation,and the left atrial function could be temporarily reduced after the operation,but could be recovered or better than that before the operation 3 months after the operation.There were no significant changes in left ventricular function.There was no significant change in left ventricular function in patients with paroxysmal atrial fibrillation.LVEDV was significantly increased 48 hours after operation in patients with persistent atrial fibrillation,and LVESD was significantly decreased 3 months after operation.2.After cryoballoon ablation of atrial fibrillation,the reverse remodeling of left atrium was not obvious,the diameter and volume of left atrium were not obviously changed compared with those before the operation,and the function of left atrium was not obviously improved.After the operation,the left ventricular volume shrunk than before,and there was no significant change in the left ventricular structure and function indicators.3.Early recurrence,persistent or long-standing persistent AF,baseline BNP level,LVEDV at 48 h after operation and LAEF level at 1 month after operation were significantly different between the recurrence group and the non-recurrence group.Early recurrence and LVEDV at 48 h after operation were independent risk factors for postoperative recurrence of AF.