The Predictive Value Of Right Ventricular Vector Flow Mapping Index For Recurrence After Catheter Radiofrequency Ablation In Patients With Atrial Fibrillation

Objective:This study applied the vector flow mapping（VFM）technique for the detection of atrial fibrillation（AF）Changes in right heart structure,function and heart cavity flow field in patients before radiofrequency ablation,Exploring the relationship between abnormal RV hydrodynamics and cardiac function,Clarify the value of the quantitative VFM technique for the assessment of systolic and diastolic function in patients with AF,By analyzing the differences of right heart structure and function and heart cavity flow field ultrasound parameters between recurrent and non-recurrent groups after RF ablation in AF patients,Seeking indicators to predict higher sensitivity and specificity of recurrence after AF,To provide a reference basis for the clinical adjustment of the treatment plan.Methods:In this study,70 patients were selected from July 1,2021 to July 31,2022,combined with medical history,70 patients with radiofrequency ablation,aged 31～89years old,underwent echocardiography before surgery,clinical data and conventional ultrasound data were collected.Vector flow mapping was also used to obtain energy loss（EL）,intraventricular pressure differences（IVPDs）,and relative pressure gradient in early systolic,late systolic,early diastolic intraventricular pressure gradients（IVPGs）.After a postoperative follow-up period of 3～6 months,Patients were divided into the relapse and non-relapse groups based on the ECG follow-up results,Comparing the differences in clinical data and conventional ultrasound parameters between the two groups,The changing characteristics of EL,IVPDs and IVPGs were also analyzed in the two groups,The Spearman correlation analysis was used to analyze the maximum EL,IVPDs,and IVPGs of the RV systolic and diastolic function,respectively,And using stepwise linear regression to analyze significantly associated risk factors for recurrence after catheter ablation in patients with AF,By drawing the ROC curve determine the diagnostic value of related factors.Results:（1）In the group of recurrence after AF catheter ablation,the AF patients had a large history of stroke and chronic heart failure,and the AF stroke risk CHA2DS2VASc score,brain natriuretic peptide precursor N-terminal pro-brain natriuretic peptide（NT-pro BNP）,and cystatin C（Cys-C）were all higher than the non-recurrence group（all P<0.05）.（2）Comparison of the two groups of ultrasound data,The left,right,left and right atrial volumes and double chamber volume index were greater than those in the non-recurrent group,RV systolic tricuspid annular systolic velocity in the relapse group tricuspid annulus systolic velocity（Tricuspids’）,rate of change in right ventricular area right ventricular fractional area change（RVFAC）)and systolic displacement of the tricuspid annulus tricuspid annular plane systolic excursion（TAPSE）were all lower compared with the non-relapse group,Right ventricular diastolic function e’was decreased compared to the non-relapse group,E/e’was increased compared to the non-relapse group（all P<0.05）.（3）Compared with the energy loss in the two groups,70 AF patients had the maximum EL,IVPDs,and IVPGs in the early contraction and relaxation stages,and the EL in the recurrent group was larger than that of the non-recurrent group,while the IVPDs and IVPGs in the recurrent group decreased compared with the non-recurrent group（P<0.05）.（4）Spearman Correlation analysis showed that,The largest global EL was negatively associated with S’,TAPSE,and RVFAC（r=-0.628,-0.649,-0.650,All P<0.05）,Both maximum global EL and E/e’in early RV diastolic（r=0.669,P<0.05）;Max IVPDs in the early RV systolic phase were positively associated with S’,TAPSE,and RVFAC,respectively（r=0.459,0.614,0.545,All P<0.05）,Both maximum IVPDs and E/e’in early RV diastolic（r=-0.609,P<0.05）;The maximum IVPGs in the early RV systolic phase were positively correlated with S’,TAPSE and RVFAC,respectively（r=0.365,0.513,0.559,All P<0.05）,Both maximum IVPGs and E/e’negatively in early RV diastolic phase（r=-0.538,P<0.05）.（5）The results of stepwise linear regression analysis showed that preoperative RAVI,EL in early systolic phase,and early relaxation EL in the patients with AF were predictive factors that significantly affected recurrence after catheter ablation in the patients with AF（P<0.05）.（6）Early contraction EL,early diastolic EL,early contraction IVPDs,early diastolic IVPDs,early contraction IVPGs and early diastolic IVPGs have good diagnostic efficacy for recurrence after catheter ablation in patients with AF,The cut values>7.72N.m^-2s^-1（AUC=0.831）,>8.12N.m^-2s^-1（AUC=0.881）,<0.93mm Hg（AUC=0.781）,<0.73mm Hg（AUC=0.812）,<0.26mm Hg/cm（AUC=0.784）,<0.20mm Hg/cm（AUC=0.783）,The test efficacy of early diastolic EL was the highest.（7）Bland-Altman analysis showed that early EL and early IVPDs were well reproducible intra-and inter-observers.Conclusions:（1）Patients with recurrence after radiofrequency and radiofrequency ablation of AF catheter often suffer from stroke,chronic heart failure and other basic diseases,and the degree of atrial ventricular remodeling is more obvious,with RAVI being the most significant change,more serious cardiac function damage,and higher NT-pro BNP and Cys-C values.（2）EL in patients with recurrent AF was increased compared with non-recurrent patients,and IVPDs and IVPGs were lower compared with non-recurrent patients,which were obvious in early contraction and early diastolic changes,and were highly associated with right ventricular contraction and diastolic function.（3）By comparing the diagnostic efficacy of the maximum global EL,IVPDs and IVPG in postoperative recurrence in patients with AF,the diagnostic effect of early EL was the best.