Clinical Study Of One-stop Catheter Ablation Combined With Left Atrial Appendage Closure In The Treatment Of Non-valvular Atrial Fibrillation

Objective:To compare the safety and efficacy of one-stop catheter ablation combined with left atrial appendage closure and atrial fibrillation ablation alone in the treatment of patients with non-valvular atrial fibrillation,and explore the role of one-stop procedure in patients with non-valvular atrial fibrillation and heart failure.Methods:One hundred and thirty-three patients who were diagnosed with non-valvular atrial fibrillation and underwent one-stop catheter ablation combined with left atrial appendage closure at the First Affiliated Hospital of University of Science and Technology of China from September 2020 to February 2022 were retrospectively included.A total of 925 patients with atrial fibrillation who received atrial fibrillation ablation in our hospital at the same time,and 518 patients who did not meet the inclusion and exclusion criteria and were not followed up after operation were excluded.from which 165 patients in the control group were screened by a simple randomized method.According to the medical records and examination results during hospitalization,the general data of the patients were obtained.During the follow-up period,the recurrence of atrial fibrillation was recorded according to the common ECG and 24-hour dynamic ECG.The left atrial diameter,left ventricular end-diastolic diameter and left ventricular ejection fraction were recorded by echocardiography.SPSS 26.0 software was used for statistical analysis.Measurement data were expressed as mean±standard deviation,and enumeration data were expressed as frequency（percentage）.Independent sample t-test or rank sum test was used to compare measurement data,and chi-square test was used to compare enumeration data,Two-way ANOVA was used to compare the effects of two independent factors,and P<0.05 was considered statistically significant.This study mainly analyzed the recurrence rate,postoperative complications,left ventricular function and cardiac-related readmission rate of atrial arrhythmia in one-stop group and control group;meanwhile,in one-stop group,the effect of atrial fibrillation with heart failure（LVEF<50%）compared with non-heart failure patients in terms of surgical efficacy,safety and postoperative complications was compared and analyzed.Results:1.A total of 133 patients with catheter ablation combined with left atrial appendage occlusion and 165 patients in ablation control group were enrolled in this study.In terms of baseline data,there was no significant difference in age（P=0.366）,gender（P=0.182）,BMI（P=0.225）,type of atrial fibrillation（P=0.308）,complications and administration of anticoagulant drugs（P=0.719）between control group and one-stop group.There were significant differences in CHA₂DS₂-VASc score,HAS-BLED score,NT-pro BNP and stroke events between control group and one-stop group（P<0.05）.Meanwhile,according to preoperative transesophageal echocardiography results,there were significant differences in left atrial diameter and left ventricular ejection fraction between the two groups（P<0.05）.Compared with the non-heart failure group,the atrial fibrillation with heart failure group had lower BMI（24.43±5.31 vs 26.05±11.06,P=0.009）,higher NT-pro BNP（1881.17±6068.83 vs 947.14±6251.86,P<0.001）,left ventricular end-diastolic meridian（58.97±14.03 vs 52.91±19.09,P<0.001）,lower CHA₂DS₂-VASc score（2.80±3.2 vs 3.31±3.69,P=0.134）,and lower HAS-BLED score（1.30±2.70 vs 2.11±1.89,P<0.001）,and the differences were statistically significant.In the one-stop group,there were 30 patients with atrial fibrillation complicated with heart failure,with mean age of 61.83±24.83 years,7female patients,9 paroxysmal atrial fibrillation,mean BMI of 24.43±5.31,preoperative CHA₂DS₂-VASc score of 2.80±3.20,HAS-BLED score of 1.30±2.70,mean NT-pro BNP of 1881.17±6068.83 pg/ml,previous history of TIA/ischemic stroke/systemic embolism in 11 patients,history of cerebral hemorrhage in 2 patients,and history of cardiac interventional surgery（non-atrial fibrillation）in 2 patients.There was no significant difference in age,gender,type of atrial fibrillation,left atrial appendage diameter,left atrial diameter,prevalence of stroke,CHA₂DS₂-VASc score,and HAS-BLED score between the two groups（P>0.05）;patients in the heart failure group had lower BMI and larger NT-pro BNP and left ventricular end-diastolic meridians compared with the non-heart failure group,and the difference was statistically significant（P<0.05）.2.There were 7 cases of perioperative complications in the one-stop group and 13cases of perioperative complications in the control group,and there was no significant difference in perioperative complications between the two groups（P=0.369）;there were 3 cases of perioperative complications in the one-stop group with heart failure and4 cases of perioperative complications in the non-heart failure group,and there was no significant difference in perioperative complications between the two groups（P=0.168）.In the one-stop group,there were 19 cases of postoperative recurrent atrial arrhythmias,4 case of residual shunt,1 case of stroke event,3 cases of bleeding event,and 11 cases of cardiac-related readmission by echocardiography;in the control group,there were 29 cases of recurrent atrial arrhythmias,4 cases of stroke event,1 case of bleeding event,and 28 cases of cardiac-related readmission.There was no significant difference in postoperative recurrence rate,stroke events,and bleeding events between the two groups,and there was a significant difference in cardiac-related readmission（P<0.05）.There were no significant differences in postoperative recurrence rate,residual shunt,stroke events,bleeding events and cardiac-related readmission rate between the one-stop group with heart failure and the non-heart failure group（P>0.05）.3.In this study,left atrial diameter,left ventricular end-diastolic diameter and left ventricular ejection fraction were used to evaluate left ventricular function.The left atrial diameter and left ventricular end-diastolic diameter in one-stop ablation group and ablation group showed a downward trend compared with those before operation,Two-way analysis of variance was further performed for the data of the two groups.There was no significant difference in left atrial diameter（P=0.107）,left ventricular end-diastolic diameter（P=0.302）and left ventricular ejection fraction（P=0.159）between the two groups,suggesting that left ventricular function was improved after operation in both groups,and the degree of improvement was equivalent.Conclusion:1.Compared with ablation alone,one-stop surgery has considerable feasibility,safety and effectiveness,and can reduce the postoperative readmission rate of patients.2.The presence or absence of heart failure in patients with atrial fibrillation does not affect the efficacy and safety of one-stop surgery.