Effect Of Pharmacologic Cardioversion And Radiofrequency Ablation On Patients With Nonvalvular Atrial Fibrillation Complicated With Pulmonary Hypertension

Purpose:To investigate the effects of different cardioversion methods(drug cardioversion and radiofrequency ablation)on pulmonary artery pressure and cardiac structure in patients with atrial fibrillation(AF)and pulmonary hypertension(PH)after cardioversion.Method:This study reviewed patients with nonvalvular atrial fibrillation(AF)combined with pulmonary arterial hypertension(PH)who underwent radiofofency ablation of atrial fibrillation(n=151,Mean follow-up time of 12.27±13.86 months)and successful cardioversion with drug therapy(n=83,mean follow-up time of 10.67±10.40 months)from January 2012 to January 2023 in the Department of Cardiovasc-ular Medicine of the Second Affiliated Hospital of Nanchang University.Electro-cardiogram(ECG),24-hour Holter(Holter)and doppler echocardiography were recorded before cardioversion and during follow-up,and electrocardiogram,24-hour Holter and doppler echocardiography were recorded in some patients with recurrent atrial fibrillation.Correlation analysis and multiple linear regression analysis were used to evaluate the effects of drug cardioversion and radiofrequency ablation cardioversion on pulmonary artery pressure and cardiac structure in patients with atrial fibrillation and pulmonary hypertension.Results:There were no significant differences in baseline data such as sex,type of atrial fibrillation,history of hypertension,type 2 diabetes mellitus,history of thyroid disease,history of dilated cardiomyopathy or heart structure between the radiofrency ablation group and the drug reversion group(P>0.05).The decrease of pulmonary artery systolic blood pressure in AF patients with PH was greater after radiofofency ablation than after drug cardioversion,especially at 4-6 months after cardioversion and at least 12 months after cardioversion(P<0.05).In mild pulmonary arterial hypertension group,radiofrequency ablation had a greater reduction in pulmonary artery systolic blood pressure than drug reversion(P<0.05).In the radiofrequency ablation group,the LAD,RAD,RVD and PA were reduced,and LVEF was increased(P≤0.05).There was no significant change in cardiac structure in the drug cardioversion group(P>0.05).Radiofrequency ablation(P=0.001)was associated with pulmonary arterial pressure in patients with atrial fibrillation and pulmonary arterial hypertension and was an independent risk factor for changes in pulmonary artery pressure.Conclusion:In this study,both radiofrequency ablation and drug reversion were able to successfully cardioversed atrial fibrillation patients with pulmonary arterial hypertension and reduce pulmonary artery pressure.The decrease of pulmonary arterial hypertension after reversion by radiofrequency ablation was greater than that by drug reversion.Radiofrequency ablation can reverse remodeling of left and right atriums and right ventricle and reduces the diameter of the pulmonary artery.Patients with AF complicated with PH may be preferentially treated with radiofrequency ablation.