Analysis Of Related Factors Of Long-term Recurrence After Initial Radiofrequency Ablation In Patients With Atrial Fibrillation

Objective:The purpose of this study is to collect the relevant clinical data of Atrial Fibrillation(AF)patients after the first radiofrequency ablation(RFCA)in our center and make statistical analysis to explore the related factors of long-term recurrence of AF patients after the first RFCA,in order to find a set of effective intervention programs and treatment ideas,reduce the recurrence rate after RFCA and bring good news to AF patients.Methods:A total of 140 AF patients[50 females(35.71%),90 males(64.29%),with an average age of 59.96±10.13 years]who received RFCA surgery under the guidance of three-dimensional electroanatomical mapping system for the first time in Department of Cardiology,the Second Hospital of Jilin University from October 2016 to December 2019 were selected,all patients had 3 or more routine electrocardiograms and/or 24-hour dynamic electrocardiograms to support the diagnosis of paroxysmal/persistent atrial fibrillation.Transesophageal echocardiography excluded left atrial appendage and left atrial thrombus,improved other related preoperative examination and preparation work,and signed an informed consent for operation.Under the guidance of 3-D electro-anatomical mapping system,experienced cardiologists performed electrophysiological examination and pulmonary vein isolation(PVI),If necessary,other surgical methods were added(such as left roof diameter ablation,superior vena cava point ablation,mitral and tricuspid isthmus ablation),and all patients recovered sinus rhythm after operation.Anticoagulant therapy was given for 3 months.Telephone follow-up was performed at the 1st,3rd,6th and 12th months after operation,and the long-term recurrence of AF was taken as the follow-up endpoint.140 AF patients were divided into two groups according to the presence or absence of long-term recurrence of AF after surgery.The clinical data of the two groups were analyzed,and SPSS25.0 statistical software was used to compare the indicators of the two groups.Then,the indicators with statistically significant differences between the two groups were analyzed by binary logistic regression to screen out the influencing factors.After that,all the influencing factors were included in the multivariate logistic regression analysis to screen out the independent influencing factors.The numerical variables were normally distributed and represented by mean±standard deviation,and the differences between groups were compared by t test.The median(upper quartile,lower quartile)was used to represent the distribution without normal distribution,and wilcoxon test is used to compare the differences between groups.Classification variables are expressed by cases(%),and differences between groups are compared byχ~2 test or Fisher exact probability method.P<0.05 is statistically significant.Using receiver operating characteristic curve(ROC curve)to evaluate the predictive efficacy of influencing factors,and the area under ROC curve(AUC)was between 0-1.0,in which 0≤AUC≤0.5 indicated that there was no predictive diagnostic value at all,0.5<AUC<0.7 indicated that the predictive diagnostic value was lower,0.7≤AUC<0.9 indicates that the predictive diagnostic value is higher,0.9≤AUC<1 indicates that the predictive diagnostic value is high;AUC=1,which is a perfect prediction without flaws.Results:1.140 patients with AF recovered sinus rhythm after operation.2.During the 12-month follow-up,44 cases(31.43%)had long-term recurrence of AF.3.Intergroup comparison of clinical data between the relapsed AF group and the non-relapsed AF group showed that compared with the non-relapsed AF group,there were statistically significant differences in gender,smoking,alcohol consumption,combined with sleep apnea,NT-pro BNP,right upper pulmonary vein diameter,right lower pulmonary vein diameter,f QRS,postoperative ACEI/ARB andβ-blockers in the relapsed AF group(P<0.05).4.The long-term recurrence rate of male patients(24.44%)was significantly lower than that of female patients(44%).The long-term recurrence rate of non-smoking patients(20.99%)was significantly lower than that of smoking patients(45.76%).The long-term recurrence rate of abstainers(24.47%)was significantly lower than that of alcoholics(45.65%).The long-term recurrence rate(18.07%)of the patients without sleep apnea was significantly lower than that of the patients with sleep apnea(50.88%).The long-term postoperative recurrence rate of patients without f QRS(26.09%)was significantly lower than that of patients with f QRS(56%).The long-term recurrence rate of patients with oral ACEI or ARB after surgery(16.39%)was significantly lower than that of patients without oral ACEI or ARB(43.04%).The long-term recurrence rate of patients with oral beta-blocker after surgery(20.93%)was significantly lower than that of patients without oral beta-blocker(48.15%).5.The results of binary Logistic regression analysis and multivariate Logistic regression analysis showed that women(OR=2.43,95%CI:1.16-5.11,P=0.0183),smoking(OR=3.18,95%CI:1.53-6.77,P=0.0022),drinking(OR=2.59,95%CI:1.23-5.51,P=0.0124),combined with sleep apnea(OR=4.7,95%CI:2.22-10.29,P=0.0001),the presence of f QRS(OR=3.61,95%CI:1.49-8.99,P=0.0049),the diameter of the right upper pulmonary vein(OR=1.15,95%CI:1.03-1.32,P=0.0227),postoperative ACEI/ARB(OR=0.26,95%CI:0.11-0.57,P=0.0011),postoperative beta blocker(OR=0.29,95%CI:0.13-0.59,P=0.001)were associated with long-term recurrence after the first RFCA in AF patients.Among them,female(OR=83.21,95%CI:11.92-1884.12,P=0.0002),smoking(OR=7.16,95%CI:1.61-51.09,P=0.0195),drinking alcohol(OR=13.01,95%CI:1.97-261.4,P=0.0238),combined with sleep apnea(OR=4.18,95%CI:1.58-11.85,P=0.0049)were independent risk factors for long-term recurrence after the first RFCA in AF patients.Postoperative oral ACEI/ARB(OR=0.28,95%CI:0.08-0.9,P=0.0351)was an independent protective factor for long-term recurrence after the first postoperative RFCA in AF patients.The difference was statistically significant.6.ROC curve results showed that:AUC(female)=0.604(95%CI:0.5166-0.6018,P<0.001),AUC(smoking)=0.64(95%CI:0.5533-0.727,P<0.001),AUC(drinking)=0.608(95%CI:0.5217-0.6951,P<0.001),AUC(combined with sleep apnea)=0.684(95%CI:0.5994-0.768,P<0.001),AUC(comprehensive index)=0.847(95%CI:0.7843-0.9094,P<0.001).Conclusion:1.Women,smoking,drinking and combined with sleep apnea are independent risk factors for long-term recurrence of AF patients after the first RFCA.The value of predicting AF long-term recurrence after the first RFCA alone is lower,but the value of predicting AF long-term recurrence after the first RCFA is higher.2.Female AF patients with smoking,drinking,apnea,f QRS and large diameter of right superior pulmonary vein are more likely to have a long-term recurrence after first RFCA.3.The long-term recurrence rate of AF patients who took ACEI/ARB andβ-blockers orally after RFCA was significantly lower than that of patients who did not take these drugs after RFCA,If patients’conditions permit,they can be used as protective drugs for AF patients after RFCA.