| Objective:Many previous studies have demonstrated that elevated plasma carbohydrate antigen-125(CA-125)levels are strongly associated with new-onset atrial fibrillation(AF)and heart failure,but data regarding the relationship between plasma CA-125 and recurrence of AF after radio frequency catheter ablation(RFCA)remains poorly investigated.The aim of the present study was to assess whether increasing plasma CA-125 levels are related to long-term AF recurrence following RFCA.Methods:A total of 353 patients with AF who underwent first RFCA in the department of cardiology,The First Hospital of Soochow University,from February 2017 to February 2020 were consecutively enrolled in this study.These AF patients were aged 29 to 82 years,with a mean age of 61.56±9.47 years,including 199(56.4%)males,96(27.2%)with persistent AF,and 257(72.8%)with paroxysmal AF.Plasma CA-125 levels were determined in all AF patients before RFCA,and general clinical data,preoperative hematological indices,echocardiographic parameters,ablation procedures,and medication history were collected from the subjects.Recurrence of AF was assessed following 12 months.The baseline characteristics were compared between the recurrence group and the non-recurrence group.Multivariable adjusted Cox models were constructed to examine the association of plasma CA-125 levels and AF recurrence,and a test for linear trend across CA-125 quartiles was performed.Kaplan-Meier survival analysis was used to compare the effect of different levels of CA-125 on the recurrence rate after RFCA of AF,and the independent risk factors affecting the recurrence of AF after the procedure were analyzed by univariate and multivariate logistic regression,using the Receiver Operating Characteristic curve and area under the curve(AUC)to assess the efficiency of predicting AF recurrence.Results:There were 85 patients(24.1%)with recurrent AF and 268 patients(75.9%)without recurrence during the 12-month follow-up interval.The CA-125 levels at baseline in patients with recurrence was significantly higher than that in patients without[(18.71±12.63)U/mL vs.(11.27±5.40)U/mL,P<0.001].The incidence of AF recurrence across increasing quartiles of CA-125 was 11.5%,13.3%,21.6%,and 50.5%,presenting a significant linear trend of increasing(P-trend<0.001).Kaplan-Meier survival analysis showed that the effect of different quartiles of CA-125 levels on the postoperative recurrence of AF existed a significant difference(Log-rank P<0.0001).The adjusted hazard ratios(aHR)of recurrent AF across increasing quartiles of CA-125 were 1.0(reference),1.085(95%CI,0.468-2.520)、1.866(95%CI,0.867-4.019)and 4.246(95%CI,2.113-8.533),exhibiting a significant linear trend of rising(P-trend<0.001).A similar effect was observed when CA-125 was analyzed as continuous variable(an aHR per unit increase in Ln CA-125=3.225;95%CI,2.258-4.606;P<0.001).When the predefined CA-125 cut-off of 13.75 U/mL was established,patients with CA-125≥13.75 U/mL had a higher risk of recurrent AF than those with CA-125<13.75 U/mL(aHR=3.540,95%CI,2.268-5.525,P<0.001).Kaplan-Meier survival analysis showed a significant difference in the effect of CA-125≥13.75 U/mL compared with CA-125<13.75 U/mL on postoperative AF recurrence(Log-rank P<0.0001).Multivariate logistic regression analysis revealed that plasma CA-125(OR= 1.121;95%CI,1.075-1.169;P<0.001),high-sensitivity C-reactive protein(OR=1.103;95%CI,1.005-1.210;P=0.040),and left atrium anteroposterior diameter(OR=1.096;95%CI,1.042-1.153;P<0.001)were independent risk factors for recurrence of AF following RFCA.The optimal cut-off value of plasma CA-125 for predicting AF recurrence was 13.75 U/mL,and CA-125 exhibited an optimal cut-off,sensitivity,specificity and AUC value of 13.75 U/ml,61.2%,79.1%and 0.748(95%CI,0.683-0.812,P<0.001),respectively.Conclusions:Elevated plasma CA-125 levels prior to RFCA are associated with a higher risk of AF recurrence and are an independent predictor of 1-year recurrence of AF following RFCA... |
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