Influencing Factors Of Left Atrial Reverse Remodeling After Radiofrequency Catheter Ablation In Patients With Atrial Fibrillation

Objective:(1)To investigate the changes of left atrial size and left ventricular function after radiofrequency catheter ablation in patients with atrial fibrillation with enlarged left atrium.(2)To investigate the independent influencing factors of left atrial reverse remodeling after radiofrequency catheter ablation in patients with atrial fibrillation with enlarged left atrium.Method: The patients who were hospitalized in the Heart Center of XX’s Hospital from January 1,2019 to September 30,2022 were treated with radiofrequency catheter ablation(RFCA)for atrial fibrillation,and preoperative echocardiography suggests patients with left atrial enlargement,cases that meet the exclusion criteria were excluded.The echocardiographic indexes such as left atrial diameter,left ventricular end-systolic diameter,left ventricular end-diastolic diameter,left ventricular ejection fraction(LVEF),left atrial volume(LAV),left atrial volume index(LAVI)and inflammatory indexes such as white blood cell,neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),fibrinogen,uric acid of the patients before operation,1 month,3 months and 6months after operation were compared.The LAV at 6 months after RFCA was compared with the LAV before RFCA,the included patients were divided into left atrial reverse remodeling group(reverse remodeling group)and left atrial nonreverse remodeling group(non-reverse remodeling group).Left atrial reverse remodeling was defined as a decrease of more than 15% in LAV measured by echocardiography 6 months after RFCA.The clinical characteristics,preoperative echocardiographic indexes and preoperative inflammatory indexes were compared between the two groups,and a multifactorial analysis of factors that may influence the occurrence of left atrial reverse remodeling after RFCA in patients with atrial fibrillation with left atrial enlargement.The ROC curve was used to analyze best critical values of independent influencing factors and diagnostic efficiency.Result: A total of 79 patients were included,the mean age was 63.8 ± 9.9years,with 70 patients(88.6%)with persistent AF and 9 patients(11.4%)with paroxysmal AF.The left atrial diameter and LAV after RFCA were significantly lower than those before operation(P < 0.05),and the LVEF was significantly higher than that before operation(P < 0.001).The left atrial diameter and LAV decreased were observed 1 month after RFCA.Patients with left atrial reverse remodeling at 3 months after operation accounted for 98.3% of all patients with left atrial reverse remodeling.The PLR after RFCA was significantly higher and the level of uric acid was significantly lower than that before operation.In this study,there were 60 patients(78.0%)in this study who had left atrial reverse remodeling 6 months after RFCA,there were 19 patients(24.1%)without left atrial reverse remodeling.The preoperative left atrial anteroposterior diameter,left atrial left and right diameter,LAV,LAVI,NLR,PLR,uric acid and white blood cell in the non-reverse remodeling group were higher than those in the reverse remodeling group(P < 0.05).After removing confounding factors,NLR,PLR and LAV can be used as independent influencing factors of left atrial reverse remodeling after RFCA in patients with atrial fibrillation with left atrial enlargement.PLR = 110.06 as the best critical value for predicting left atrial reverse remodeling,it has high sensitivity(71.67%)and specificity(89.47%).Conclusion:(1)Patients with atrial fibrillation with left atrial enlargement began to show reverse left atrial remodeling and improvement in left ventricular function 1 month after RFCA,and most patients had reverse left atrial remodeling3 months after RFCA;(2)NLR,PLR and LAV are independent factors affecting left atrial reverse remodeling after RFCA in patients with atrial fibrillation with enlarged left atrium,PLR has high specificity and sensitivity in predicting left atrial reverse remodeling.