Effect Of "One-Stop" Procedure On Cardiac Function And Risk Factors Of Recurrence In Patients With Atrial Fibrillation

Objective To explore the effects of cardiac radiofrequency ablation combined with left Atrial ear occlusion（one-stop）procedure on the heart structure and function of Atrial Fibrillation（AF）patients compared with simple cardiac radiofrequency ablation,and analyze the risk factors of AF recurrence after one-stop procedure.Methods Fifty AF patients admitted to the Department of Cardiovascular Medicine,Affiliated Hospital of Qingdao University from January 2019 to December 2021 for one-stop procedure（one-stop group）were retrospectively included as the experimental group,and 50AF patients with high risk of thromboembolism（ablation group）who were also admitted to the Department of Cardiovascular Medicine,Affiliated Hospital of Qingdao University for RF cardiac ablation only as the control group.Baseline data,preoperative cardiac structure and function indexes（Left atrial diameter[LAD],Left atrial ejection fraction,Left atrial ejection fraction,）were compared between the one-stop group and the ablation group.LAEF],Left atrial diameter volume index[Left atrial diameter volume index,LAVI],left ventricular diameter[left ventricular diameter,LVD],Left ventricular ejection fraction（LVEF）,and postoperative recurrence.In addition,multivariate Logistic regression analysis was used to evaluate the risk factors of late relapse in the One-Stop group.SPSS 27.0 system was used for data analysis,and P<0.05 was considered statistically significant.Results1.The study finally included 50 patients in the one-stop group and 50 patients in the ablation group.There were no significant differences in age,sex,body mass index,AF type,CHA₂DS₂-VASc score,HAS-BLED score,smoking history,drinking history,past medical history,antiarrhythmic drugs and other baseline data between 2 groups（P>0.05）.2.2.Patients in each group were divided into two subgroups,the persistent group and the recurrent group,to compare the changes of cardiac structure and function indexes,respectively.Patients in the recurrent group had sinus rhythm when undergoing cardiac ultrasound before procedure,and 30 patients with recurrence were excluded from the indexes one year after procedure.There were no significant differences in the preoperative LAD,LAEF,LAVI,LVD and LVEF between the one-stop group and the ablation group（P>0.05）.There were no significant differences in the preoperative LAD,LAVI,LVD and LVEF between the one-stop group and the ablation group in the continuous group（P>0.05）.In the paroxysmal AF group,the LAD in the one-stop group one month after procedure was increased compared with that before procedure（t=-2.419,P=0.02）,and the LAD in the ablation group had no significant change compared with that before procedure（P>0.05）.Comparison between groups showed that the LAD in the ablation group was lower than that in the one-stop group（t=2.117,P=0.04）;At 1 year after procedure,ultrasound indexes in both groups were the same as baseline,and there was no significant difference between the two groups（P>0.05）.In the persistent AF group,there was no significant difference in ultrasound indexes between the one-stop group and the ablation group at 1 month after procedure compared with baseline,and no significant difference in ultrasound indexes between the two groups（P>0.05）.One year after procedure,the LAD（t=3.120,P=0.012）and LAVI（t=4.225,P=0.002）in the one-stop group were smaller than those before procedure.In the ablation group,LAD（t=2.117,P=0.040）,LAVI（t=2.117,P=0.040）was also smaller than that before procedure;There were no significant differences in ultrasound indexes between the one-stop group and the ablation group before and at 1 year after procedure（P>0.05）.3.There was no statistical difference in perioperative complications between the two groups.The early postoperative recurrence rate in the one-stop group was higher than that in the ablation group（24%vs.16%）,and the recurrence rate within 3 months to 1 year in the one-stop group was higher than that in the ablation group（48%vs.36%）,but the differences were not statistically significant（P>0.05）.Univariate analysis showed that AF nature（χ2=4.975,P=0.03）,early recurrence（χ2=7.878,P=0.005）,age（t=-2.693,P=0.011）,preoperative LAD（t=-6.344,P<0.001）,preoperative LAVI（t=-6.296,P<0.001）affected the recurrence rate of AF after one-stop surgery;Logistic multiple factor regression analysis showed that preoperative LAD（OR 1.817,95%CI 1.186-2.783,P=0.006）was an independent risk factor of atrial fibrillation recurrence after one-stop procedure（preoperative LAVI was not included due to collinearity with LAD）.Conclusions1.The left atrium of paroxysmal AF patients was slightly enlarged early after one-stop procedure,and there was no difference from baseline level 1 year after procedure,while there was no significant change in the ablation group early after procedure and 1 year after year.The left atrial function of patients with persistent AF did not change in the early postoperative period,while the left atrial structure of the one-stop group and the ablation group was improved 1 year after procedure,and the degree of improvement was not significantly different between groups.2.Compared with radiofrequency ablation alone,one-stop procedure did not affect the recurrence rate of AF,nor did it increase the incidence of long-term and serious postoperative complications in the perioperative period.3.Early recurrence was an independent risk factor of AF recurrence after one-stop procedure.