Protective Effect Of Catheter Ablation On Atrial Fibrillation With Ejection Fraction Preserved Heart Failure

Objective To explore the effect of catheter ablation on patients with atrial fibrillation（AF）and ejection fraction preserved heart failure（HFpEF）by measuring the relevant echocardiographic parameters,biological indexes of heart failure,recurrence of atrial arrhythmia and readmission of cardiovascular events.Methods 1.A total of 83 patients with definite diagnosis of atrial fibrillation who received the catheter ablation and met the diagnostic criteria of ejection fraction preserved heart failure were selected as HFpEF group.At the same time,129 patients with non heart failure who underwent atrial fibrillation catheter ablation in the same period were selected as the control group.2.The basic information of each patient was recorded,including sex,age,height,weight,NYHA cardiac function classification,type of atrial fibrillation,hypertension,hyperlipidemia,diabetes,coronary atherosclerotic heart disease,stroke,chronic obstructive pulmonary disease,pacemaker implantation status,and Body mass index（BMI）was calculated,glomerular filtration rate,NT-proBNP level and echocardiographic parameters were measured,including left atrial diameter（LAD）,left ventricular ejection fraction（LVEF）,left ventricular end diastolic diameter（LVIDd）,maximum blood flow velocity in early diastolic phase of mitral valve（E peak）,maximum blood flow velocity in late diastolic phase of mitral valve（A peak）,maximum motion velocity in early diastolic phase of mitral valve（e’）,and E/e’ and E/A were calculated.3.We compared the changes of echocardiographic parameters and NT-proBNP levels between HFpEF group and non HF group,and analyzed the recurrence of postoperative atrial arrhythmia and readmission of cardiovascular events,so as to explore the benefit of catheter ablation in patients with atrial fibrillation complicated and ejection fraction preserved heart failure.Results 1.The postoperative echocardiographic parameters（LVEF,LAD,E/e’,E/A）and NT-proBNP level in HFpEF group were improved compared with those before operation（P<0.05）.2.The NYHA cardiac function grade after operation was improved in HFpEF group（P<0.05）.3.Kaplan Meier survival analysis showed that there was no significant difference in atrial arrhythmia recurrence and cardiovascular event readmission between the two groups.4.Regression analysis showed that persistent atrial fibrillation was positively correlated with postoperative recurrence of atrial arrhythmia[OR=4.068,95%CI=1.049－15.773,P=0.042],larger preoperative LVEF was negatively correlated with postoperative recurrence of atrial arrhythmia[OR=0.645,95%CI=0.488-0.852,P=0.002],and higher preoperative NT-proBNP level was positively correlated with postoperative recurrence of atrial arrhythmia[OR=1.002,95%CI=1.001-1.004,P=0.005];Atrial arrhythmia recurrence was positively correlated with postoperative cardiovascular event readmission[OR=9.212,95%CI=2.582-32.872,P=0.001],and hyperlipidemia was positively correlated with postoperative cardiovascular event readmission[OR=6.191,95%CI=1.19-32.207,P=0.03].5.The regression equation is obtained by linear regression analysis:Δ LAD（postoperative pre operation）=-0.271+0.37*hyperlipidemia+0.239*diabetes;Δ LVEF（postoperative preoperative）=27.545-4.16*preoperative LVIDd.6.The ROC curve of persistent atrial fibrillation,preoperative NT proBNP and preoperative LVEF was used to predict the recurrence of postoperative atrial arrhythmia.The area under the curve（AUC）was 0.876（95%CI[0.785,0.938],P<0.05）,the sensitivity was 78.79%,and the specificity was 88%.Conclusion For patients with AF and HFpEF,catheter ablation can improve left ventricular function,alleviate symptoms of heart failure,promote reverse remodeling of left atrium,and is not inferior to patients with AF in terms of postoperative recurrence of atrial arrhythmia and readmission of cardiovascular events.Persistent AF,smaller preoperative LVEF,higher preoperative NT proBNP levels were found to be predictors of postoperative AF recurrence,while atrial arrhythmia recurrence,combined preoperative hyperlipidemia were predictors of readmission for postoperative cardiovascular events;Hyperlipidemia and diabetes are not conducive to the reduction of LAD after operation.Larger LVIDd before operation is not conducive to the improvement of LVEF after operation.