Comparison Of Atrial Premature Beat Load After Two Different Ablation Methods For Paroxysmal Atrial Fibrillation

Background:Atrial fibrillation(AF),as the most common supraventricular arrhythmia disease,affects the health of more than 30 million patients worldwide[1].The total prevalence rate is about 0.7%,which increases with age[2].The main diagnosis of AF is based on the characteristics of ECG:disappearance of P wave,F wave with different shapes and sizes,unequal absolute RR interval,normal QRS interval(QRS wave broadening may occur when combined with ventricular differential conduction).Atrial fibrillation can not only cause palpitation,chest tightness,shortness of breath and other discomfort,but also result in systemic arterial embolism,affecting the health of patients.Paroxysmal atrial fibrillation(PAF)is characterized by atrial fibrillation lasting less than 7 days(usually less than 48 hours),which can be converted automatically.At present,the treatment of paroxysmal atrial fibrillation is conservative by mainly using drugs and radiofrequency catheter ablation.With the continuous development of radiofrequency catheter ablation,it was found that the mechanism of occurrence and maintenance of paroxysmal atrial fibrillation is strongly related to the pulmonary vein muscle sleeve potential.As a result,the circumferential pulmonary vein isolation(CPVI)has become the mainstream procedure of catheter ablation for paroxysmal atrial fibrillation.On the basis of CPVI,pulmonary vein isolation combined with left atrium ablation(CPVI+LARA)and supplementary ablation of left atrial posterior wall,isthmus of mitral annulus and left atrial fragmentation potential have been developed.However,according to statistics,the average success rate of radiofrequency ablation for paroxysmal atrial fibrillation is 70%,and a considerable number of patients still face the risk of recurrence.A large number of studies have shown that the risk of recurrence after radiofrequency surgery is mainly related to age,cardiovascular risk factors,gender,left atrial diameter and other factors.Some recent research showed that the atrial premature beats after atrial fibrillation surgery can be used as an independent predictor of the recurrence of atrial fibrillation.Objective:This thesis intends to compare CPVI(Circumferential Pulmonary Vein Isolation)with CPVI+LARA(CPVI combined with Left Atrium Roofline Ablation)to optimize the strategy of radiofrequency ablation in the treatment of paroxysmal atrial fibrillation and reduce the recurrence rate of patients with paroxysmal atrial fibrillation.Methodology:A total of 91 patients with paroxysmal atrial fibrillation who were willing to accept the radiofrequency ablation after the ineffective conservative treatment from September 2016 to June 2019 were retrospectively analyzed.The patients were divided into two groups:CPVI group(n=46)and CPVI+LARA group(n=45).The patients were followed up within 1 year to evaluate the incidence of frequent atrial premature beats and its influence on the late recurrence of atrial fibrillation.Then the differences of the baseline data such as the total time of radiofrequency ablation,the total amount of radiation exposure and the total time of radiation exposure between the two groups were analyzed.Results:12 cases(26.09%)in group A and 17 cases(37.78%)in group B were observed with frequent atrial premature beats(>720/24h).No significant difference is obtained in the incidence of frequent atrial premature beats between the two groups.No significant difference is observed in the recurrence rate between frequent and non-frequent premature atrial contractions.No significant difference was observed in preoperative and intraoperative baseline data between group A and group B.Also,no significant difference was observed in the late recurrence rate of AF between frequent and non-frequent premature atrial contractions.Conclusions:Compared with CPVI+LARA,shorter average operation time,radiofrequency ablation time,and total exposure time and less total exposure amount were observed for CPVI.There was no significant correlation between the frequent atrial premature beats and the late recurrence of paroxysmal atrial fibrillation.