| BackgroudAtrial fibrillation is one of the most common arrhythmia, its prevalence is increasing gradually. Atrial fibrillation always leads to some serious cardiovascular events like embolism and stroke. It’s often treated with drugs, but the effectiveness and security are limited, now, the Catheter Radiofrequency Ablation is greatly welcomed in treating atrial fibrillation due to the high effectiveness and low side-effects. It has been demonstrated that atrial fibrillation can cause the left atrial and left ventricular enlargement and dysfunction, consequently, the enlarged left atrium will worsen the atrial fibrillation. So after the atrial fibrillation is controlled, whether the left atrial and left ventricular structure and function of the would recovery has an important impact on the patients’ prognosis. And the structure and function change after the Catheter Radiofrequency Ablation also draw a lot of attention.Objective:To study the effect of Catheter Radiofrequency Ablation on persistent atrial fibrillation patients’ left atrial and ventricular structure and function, test the preoperative and postoperative data about the left atrial and ventricular structure and function(left atrium anterior-posterior diameter(LAD), left ventricular end-diastolic diameter(LVEDD), left ventricular end-systolic diameter(LVESD)、left ventricular fractional shortening(FS), left ventricular ejection fraction(LVEF), brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP)) of Persistent Atrial Fibrillation patients who received the Catheter Radiofrequency Ablation., then compare the change before and after the operation of the successful group and failure group. To compare the preoperative indexes(age, course, LAD, NT-ProBNP) between the successful and failure groups to study whether they can be the prognostic indicators of the Catheter Radiofrequency Ablation.Method:Fifty-seven Persistent Atrial Fibrillation patients who underwent Catheter Radiofrequency Ablation in peking union medical college hospital during January 2013 to November 2015 were collected. Consulted the medical record to obtain the basic information such as sex, age, course, body mass index(BMI), preoperative LAD、 LVEDD、LVESD、FS. LVEF and BNP、NT-proBNP.After at least six months follow up, contacting the patients through the phone, inquired the symptoms, performed holter to judge the success or failure. To repeat Echocardiography(ECHO) to get the data of LAD,LVEDD,LVESD,FS,LVEF, drew blood to test BNP and NT-proBNP. Compared the preoperative and postoperative data of the successful and failure group, and compared the preoperative data of the successful and failure group.Results:1. A total of 32 patients completed the follow-up study, the basic information of the 32 patients was showed following:age 58.71 ± 12.36(28 of them were among 40-70 years old), preoperative LAD 42.56±4.41 mm(all were lower than 50mm), preoperative LVEF 64.81±8.83%(3 of them were lower than 55%), preoperative NT-proBNP 26.71± 624.29pg/ml.2. Among them 24 were successful and 8 were failed, the success rate was 75%. There were no significant difference between the two groups on age, course, BMI, preoperative LAD/LVEF/NT-proBNP, P values were all>0.5. This indicated that for the patients included in the research, age, course, preoperative LAD/LVEF/NT-proBNP couldn’t be the prognostic predictive factor.3. Carried on the logistic regression analysis of the preoperative indexes and the recurrence after the operation, the results showed that the OR were different, but the P values were all>0.05, no significant difference were found. This also indicated that for the patients included in the research, age, course, preoperative LAD/LVEF/NT-proBNP couldn’t be the prognostic predictive factor.4. In successful group, the significant difference was found between the preoperative and postoperative LAD, P value<0.05, this indicated that the left atrium would reverse remodel after the successful operation. However, P values on LVEDD,LVESD,FS,LVEF were 0.535,0.507,0.914,0.448, all>0.05, no significant difference. But when we focused on the 3 patients whose preoperative LVEF were lower than 55%, their LVEF really increased after the operation.5. In failure group, P value on LAD,LVEDD,LVESD,FS,LVEF were 0.535, 0.507,0.914,0.448, all>0.05, no significant difference was found before and after the procedure, it showed that the structure and function didn’t become worse even after the failed operation.6. There was a significant difference on preoperative NT-proBNP(successful group 1014.71±601.99pg/ml vs failure group 450.71±516.27pg/ml, P value=0.048<0.05), but that in the successful group was higher than in the failure group.7. After the procedure, NT-proBNP obviously reduced, P<0.05,in successful group; and it was obviously rised,P=0.03<0.05, in failure group. Both of them had the significant difference.Conclusion:1. Catheter Radiofrequency Ablation is an effective treatment for atrial fibrillation, it can help to maintain the sinus rhythm.2. After the successful ablation, the left atrium can remodel. But for the patients whose preoperative left ventricular structure and function is normal, no obvious change can be found in LVEDD/LVESD/FS/LVEF, more research is needed.3. For patients between 40-70 years old in this research, this research indicates that the age can’t be the prognosis indicator.4. For the persistent atrial fibrillation included in this research, the course can’t predict the prognosis. 5. For patients whose preoperative LAD is lower than 50mm, this research don’t support that the preoperative LAD can predict the prognosis.6. When the preoperative LVEF don’t drop lower than 55%, this research shows that the LVEF can’t be the prognostic predictive factor.7. After the atrial fibrillation is controlled by ablation, the NT-proBNP can obviously reduce.8. The reduce of NT-proBNP after the operation can be the predictive factor of prognosis.9. For the asymptomatic cardiac dysfunction patients, NT-proBNP has more advantage than LVEF in testing. |
PDF Full Text Request