| Background and Objective :Atrial fibrillation(AF)is one of the most common tachyarrhythmia in clinic.Atrial fibrillation not only causes patients to feel flustered and uncomfortable,but also significantly increases the risk of stroke,heart failure,death and other diseases.Catheter ablation is a reliable treatment scheme for patients with poor efficacy or poor compliance with oral drug therapy,which is recommended by domestic and foreign guidelines(Class IIa).However,the mechanism of atrial fibrillation is not very clear.At present,patients with atrial fibrillation treated by catheter ablation still have a high risk of recurrence after surgery,and patients will still be exposed to the high risk of stroke.More than 90% of thrombus in patients with atrial fibrillation comes from the left atrial appendage.Because of its complex anatomical structure,the left atrial appendage is prone to cause blood stasis in the left atrial appendage.The endothelial dysfunction of the left atrial appendage and the hypercoagulable state of blood further make the left atrial appendage easy to form thrombus.Left atrial appendage closure is an effective treatment to prevent left atrial appendage thrombosis caused by atrial fibrillation.The one-stop treatment strategy of catheter ablation combined with left atrial appendage closure can not only control the heart rhythm and restore sinus rhythm,but also prevent the occurrence of ischemic stroke.There have been many small sample studies at home and abroad to confirm its safety and effectiveness,but there are relatively few relevant research on Chinese people.The one-stop treatment involves catheter ablation and left atrial appendage closure simultaneously,which takes a long time and is difficult to operate.Whether its safety and effectiveness are lower than that of simple radiofrequency ablation in Chinese.At the same time,left atrial appendage closure not only changes the original anatomical structure of the heart,excludes the left atrial appendage from circulation,affects the blood flow velocity and direction of the left atrium,but also affects the electrophysiological characteristics and neurohumoral secretion of the left atrial appendage and left atrium.In addition,the left atrial appendage itself is also one of the sources of atrial fibrillation.Therefore,we speculate whether one-stop treatment will affect the recurrence of atrial fibrillation after ablation? The aim is to explore the safety and effectiveness of one-stop treatment by comparing the success rate,perioperative and follow-up adverse events and prognosis between one-stop treatment and radiofrequency ablation alone.At the same time,we analyzed the effect of one-stop treatment on the recurrence after ablation compared with simple radiofrequency ablation,and conducted subgroup analysis to explore the factors affecting the recurrence of atrial fibrillation,in order to provide reference for clinical treatment.Methods:This study is a retrospective study.We collected 109 patients with atrial fibrillation who underwent one-stop treatment(radiofrequency ablation combined with left atrial appendage closure)during their hospitalization in the Department of Cardiovascular Medicine of our hospital from December 2019 to December 2021,and 301 patients who underwent simple radiofrequency ablation at the same time.Among them,radiofrequency ablation was based on circumferential pulmonary vein electrical isolation,and linear ablation was performed according to the habit of the operator.The operation sequence of ablation and then closure was adopted in one-stop treatment,and Watchman occluder was used in all occluders.Both groups were treated with anticoagulant and antiarrhythmic drugs within 3 months after the operation.After 3 months,the simple radiofrequency ablation group chose whether to continue anticoagulation according to the CHA2DS2-VASc score.The one-stop treatment adjusted the anticoagulant to dual antiplatelet drugs after 3 months of operation,and gave a single antiplatelet drug for long-term maintenance treatment six months after taking it.All patients were followed up for at least 12 months.Collect the clinical baseline data,preoperative laboratory test,imaging examination data,perioperative conditions,postoperative review data 1.5,3,6,12 months,and annual prognosis of the two groups of patients.The success rate of surgery,adverse events during perioperative period,recurrence of atrial fibrillation,stroke during follow-up,and prognosis in the two groups were statistically analyzed to evaluate whether one-stop treatment is safe and effective.At the same time,the recurrence in the two groups was analyzed by subgroup analysis to explore the risk factors of recurrence of atrial fibrillation after ablation.Results:1)A total of 410 cases were included,including 109 cases of one-stop treatment and 301 cases of simple radiofrequency ablation.There was no significant difference between the two groups in age,gender,course of disease,BMI,CHA2DS2-VASc score,HAS-BLED score,type of atrial fibrillation,and complications(hypertension,diabetes,coronary heart disease,stroke),all P>0.05.2)There was no significant difference between the two groups in white blood cell count,neutrophil count,ALT,AST,uric acid,creatinine,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,NLR,LAD,LVD,LVEF,and other tests and test results,P>0.05.3)There was no statistically significant difference between the two groups in terms of intraoperative treatment parameters,perioperative complications and postoperative medication(P>0.05).4)During the follow-up period of the two groups,the one-stop treatment group was followed up for 15(12,18)months,and there were no cases of ischemic stroke,while the radiofrequency ablation group was followed up for 14(12,18)months,with 9 cases of ischemic stroke;Bleeding occurred in 7 cases(6.42%)in the one-stop treatment and 17cases(5.65%)in the radiofrequency ablation group.There was no significant difference between the two groups;One case of occluder thrombus occurred in the one-stop treatment,and the thrombus disappeared after intensive anticoagulation treatment.5)The recurrence rate of blank period in one-stop treatment was significantly higher than that in radiofrequency ablation group(P=0.006);There was no significant difference in the long-term recurrence rate between the two groups(P>0.05).6)Multivariate logistic regression analysis found that the larger left atrial diameter(OR:1.072,95% CI: 1.003~1.146,P=0.041),the longer duration of atrial fibrillation(OR:1.014,95% CI: 1.005~1.024,P=0.002),persistent atrial fibrillation(OR: 2.132,95% CI:1.238~3.671,P=0.006)and postoperative recurrence of atrial fibrillation in the blank phase(OR: 2.270,95% CI: 1.186~4.345,P=0.013)were independent risk factors for recurrence of atrial fibrillation after simple radiofrequency ablation;The duration of atrial fibrillation is longer(OR: 1.028,95% CI: 1.003 ~ 1.054,P=0.027),the score of CHA2DS2-VASc is higher(OR: 1.558,95% CI: 1.024~2.371,P=0.039),the left atrial diameter is larger(OR: 1.257,95% CI: 1.068 ~ 1.479,P=0.006)Persistent atrial fibrillation(OR: 3.648,95% CI: 1.267~10.505,P=0.016)and postoperative recurrence of atrial fibrillation in blank phase(OR: 6.439,95% CI: 2.054 ~ 20.184,P=0.001)are independent risk factors for recurrence of atrial fibrillation after one-stop treatment.Conclusions:1)Compared with simple radiofrequency ablation,one-stop treatment does not significantly increase the complications and adverse events of surgery,does not significantly affect the closure effect of left atrial appendage,and can effectively prevent the occurrence of ischemic stroke events.One-stop treatment is safe and effective in the treatment of atrial fibrillation;2)Compared with simple radiofrequency ablation,one-stop treatment may increase the risk of recurrence of atrial fibrillation in the blank period after ablation,but there is no significant difference between the two groups in the recurrence rate after 3 months of surgery;3)The longer course of disease,the type of atrial fibrillation is persistent atrial fibrillation,the larger left atrial diameter,and the recurrence in blank period are independent risk factors for recurrence after simple radiofrequency ablation of atrial fibrillation.The longer course of disease,the type of atrial fibrillation is persistent atrial fibrillation,the higher CHA2DS2-VASc score,the larger left atrial diameter,and the recurrence in blank period are independent risk factors for recurrence after one-stop treatment,which need to be confirmed by multi-center and large sample. |
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