| Objective: To investigate the changes of cardiac function and the influence of prognosis in patients with atrial fibrillation and heart failure after the radiofrequency ablation follow-up for 1 year.Method: In this study,we collected 105 patients with atrial fibrillation and heart failure who underwent radiofrequency ablation in the First Hospital of Lanzhou University from January 2018 to December 2019.By collecting preoperative baseline data,ablation methods,postoperative complications and postoperative follow-up data,patients were retrospectively analyzed in left ventricular ejection fraction(LVEF),left atrial size(LAD),left ventricular end systolic diameter(LVDs),left ventricular end-diastolic volume(LVEDV),N terminal brain natriuretic peptide precursor(NT-pro BNP)and NYHA cardiac function grade.The primary outcome was the changes of the above indexes 1 year after operation compared with those before operation.The secondary outcome was to count the number of patients with atrial fibrillation and heart failure due to recurrence of atrial fibrillation and re-hospitalization due to heart failure after discharge,Patients were divided into the group: with patients with AF recurrences and patients without AF recurrences,and compared to try to determine the related factors for recurrence of atrial fibrillation,and the influencing factors for recurrence of atrial fibrillation and rehospitalization of heart failure were analyzed by logistic multivariate regression model.Results: 1.The average age of the patients selected in this study was61.62 ±9.24 years old,of which 35.24% were women,with a total of 37 cases.Among the types of atrial fibrillation,paroxysmal atrial fibrillation was 61,persistent atrial fibrillation was 44.patients with preserved e jection fraction accounted for 85.7%,and 14.3% of patients with reduced ejection fraction and intermediate heart failure.2.All the patients in this study underwent radiofrequency ablation successfully.59% of the patients only received pulmonary vein isolation(PVI),41% of patients underwent additional ablation.The overall incidence of postoperative complications was 4.9%,including 1 patient with acute pericardial tamponade,1 patient with pericardial effusion,and 3 patients with inguinal hematoma.3.The average LVEF of patients included 12 months after ablation was 58.22±6.28%,which was a slight increase compared to preoperatively,but the difference was not statistically significant(P >0.05).The changes of LAD,LVDs,LVEDV,NT-pro BNP and NYHA grades from baseline to 12 months after operation were 38.9±0.56 to 34.7±0.44(P<0.01),58.5±0.73 to55.1±0.61,(P<0.01),129.63±40.08 to 116.91±23.99(P<0.01),735.00(322.50-1733.50)to 258.00(121.00-563.50)(P<0.01),2.21±0.47 to2.06±0.46(P<0.01)respectively.The above para-meters showed a downward trend compared with the baseline data,and the difference was statistically significant.4.74 patients(70.48%)maintained sinus rhythm 12 months after ablation,and 31 patients(29.52%)relapsed.Divide patients into AF recurrence group(n=31)and non-recurrence group(n=74).Statistical analysis showed that postoperative recurrence was related to the duration of atrial fibrillation,preoperative LAD,preoperative NYHA grade and preoperative NT-pro BNP.The results of logistic multivariate regression analysis showed that LAD [OR=3.551,95%CI(1.459-8.645),P=0.033] and the duration of atrial fibrillation [OR=1.014,95%CI(1.001-1.028),P=0.005]were important influencing factors of recurrence in patients with atrial fibrillation and heart failure after radiofrequency ablation.5.18 patients(17.14%)were re-hospit alized due t o heart failur e,Univar iat e analys is wit h Logist ic regressio n model showed t hat preoperat ive LVE F,LAD,LVDs,LVEDV,NT-pro BNP,NYHA grade,ur ic acid and recurrence o f at r ial fibr illat ion were associat ed wit h rehospit alizat ion o f heart failure,and recurrence o f at r ial fibr illat io n was the important factors affecting the rehospitalization of heart failure after multivariate regression analysis.Conclusion: 1.The patients with atrial fibrillation and heart failure were followed up for 1 year after radiofrequency ablation.Comparing with the patients before operation,the cardiac function was improved and the atrium and ventricle remodeling were reversed.2.Left-atrial size and duration of atrial fibrillation are important influencing factors of recurrence in patients with atrial fibrillation and heart failure after radiofrequency ablation.Recurrence of atrial fibrillation was the important factors affecting the re-hospitalization of heart failure. |
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