| BackgroundAtrial fibrillation(AF)is the most common arrhythmia in clinical practice.Catheter ablation is one of the most important treatments to help AF patients to restore sinus rhythm,especially for those who are refractory or intolerant to antiarrhythmic drugs.Recurrence of AF after catheter ablation is a common complication of this procedure.It is usually classified into early recurrence(i.e.Recurrence within the "blanking period")and late recurrence,the latter commonly seen as failure of the procedure.Studies show that late recurrence can be predicted by early recurrence,the latter suggested in other studies to be related with many risk factors such as age,past medical history,pre-procedure drugs like statins or ACEI/ARBs and Left Ventricular Ejection Factor(LVEF)as well as left atrial diameter in echocardiograms.However,monitoring device such as 24h-holter and 12-lead electrocardiogram in most studies may lower the detection rate of AF recurrence and thus make results inaccurate,and the implantable long-time loop recorder may limit its use by its invasive implanting procedure.Therefore,a newer monitoring device is needed to study the recurrence of AF after ablation.ObjectiveThe present study used a surface 7-day electrocardiogram to study risk factors of AF early recurrence after catheter ablation.MethodA total of 56 inpatient AF patients who underwent catheter ablation from 1st March 2016 to 31st May 2016 and 1st Nov.2016 to 11th May in Peking Union Medical College Hospital were included.The following information was recorded:Age,gender,BMI,duration of AF,type of AF(Paroxysmal/Persistent),pre-procedure drugs(statin,ACEI/ARB,antiarrhythmic),echocardiogram data(LVEF,LAD,LVIDS,LVIDD),pre-procedure eGFR and NT-proBNP,technique of ablation,method of cardioversion during the procedure,post-procedure antiarrhythmic drugs.7-day electrocardiogram device was installed immediately after the procedure,and 7-day ECG data was collected and analyzed.Existence of any recorded AF pattern longer than 30 seconds on ECG within 7 days post procedure was defined as early recurrence of AF.Results1.A total of 17(30.39%)of the 56 AF patients were detected of early AF recurrence after ablation,7(41.2%)of which had paroxysmal AF and 10(58.8%)had persistent AF before the procedure.No atrial tachycardia was detected on anyone.2.For unclassified data:In univariable analysis,1(5.9%)vs 16(41.0%)with DM history were recorded in early recurrence and no recurrence group,p=0.009;LVEF were 59.76±7.32 vs 67.79±8.31 in each group,p<0.001;9(52.9%)vs 9(23.1%)in each group were recorded with post-procedure type II antiarrhythmic drugs,p=0.028.In multivariable analysis,Coronary artery disease(95%CI:4.598-12199.147,p=0.007),low LVEF(95%CI:0.699-0.915,p=0.001),post-procedure type II antiarrhythmic drugs(95%CI:0.013-0.756,p=0.026)were positively related to post-ablation early recurrence with statistical significance while other recorded factors were not.ROC curve was plotted based on LVEF and whether there was early recurrence.Area under the curve was 0.779(95%CI:0.657-0.901,p<0.001).When LVEF<50%,which is the clinical cutoff of abnormality,its specificity of predicting AF early recurrence was 97.4%and sensitivity was 11.8%.3.For classified data(Paroxysmal group):In univariable analysis,0(0.0%)vs 11(47.8%)with DM history were recorded in early recurrence and no recurrence group,p=0.021;1(14.3%)vs 13(56.5%)with pre-procedure ACEI/ARB drug were recorded in each group,p=0.050;0(0.0%)vs 9(39.1%)with pre-procedure statin drugs were recorded in each group,p=0.048;LVEF were 61.14±4.63 vs 69.61±7.06 in each group,p<0.006.In multivariable analysis,low LVEF(95%CI:0.652-0.964,p=0.020)were positively related to post-ablation early recurrence with statistical significance while other factors were not.ROC curve was plotted based on LVEF and whether there was early recurrence.Area under the curve was 0.851(95%CI:0.709-0.993,p=0.006).When LVEF<56%,its specificity of predicting early recurrence was 100.0%and sensitivity was 14.3%.4.For classified data(Paroxysmal group):In univariable analysis,10(0.0%)vs 5(25.0%)with pre-procedure type ?anti arrhythmic drugs were recorded in early recurrence and no recurrence group,p=0.049;7(70.0%)vs 4(25.0%)with post-procedure type ? antiarrhythmic drugs were recorded in each group,p=0.024.In multivariable analysis,post-procedure type ? antiarrhythmic drugs(95%CI:0.024-0.833,p=0.031)were negatively related to post-ablation early recurrence with statistical significance while other factors were not.Conclusions1.For AF patients,early recurrence rate is 30.3%within 7 days after catheter ablation;2.Past medical history such as diabetes mellitus and coronary artery disease,has limited predicting value of early AF recurrence within 7 days after catheter ablation;3.Low LVEF has good predicting value of early AF recurrence within 7 days after catheter ablation;4.For AF patients,type ? antiarrhythmic drugs can lower early AF recurrence rate within 7 days after catheter ablation. |
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