| Atrial fibrillation(AF)has increasingly aroused the concern of the world.With increasing age,the incidence of atrial fibrillation increased year by year.The biggest harm of atrial fibrillation is cerebral apoplexy.Number of atrial fibrillation is estimated to be 33.5 million people around the world,and the prevalence increased with age,2060 cases of patients with atrial fibrillation is expected to add 2 times.Due to the growing numbers of hospitalized atrial fibrillation,the incidence of atrial fibrillation is significantly more than those of the acute myocardial infarction and heart failure.The main purpose of the treatment of atrial fibrillation is to alleviate clinical symptoms,prevent thromboembolism,eventually reduce morbidity and mortality,and to restore sinus rhythm is a positive method of the treatment of atrial fibrillation.At present,the treatment methods of atrial fibrillation include the following aspects: drug treatment including converting,ventricular rate control and anticoagulation;Radiofrequency catheter ablation(RFCA);Cryoballoon catheter ablation(CBCA);the surgical maze,etc.Current therapy of catheter ablation of atrial fibrillation as an effective means of converting and maintaining sinus rhythm,the rhythm control of atrial fibrillation is playing an important role.As early as in the middle of the 20 th century,MOE discovered the "more standeth upon wave" theoriy,according to the theory CoX proposed the innovative maze procedure.In 1994,Hassaguerre operating heart surgery in the room had a breakthrough,and found in ablation surgery of atrial fibrillation,the importance of trigger focal of atrial fibrillation,which opened a new era by catheter ablation in the treatment of atrial fibrillation.Since 1999,the first domestic catheter ablation of atrial fibrillation since,has made great progress.International guidelines have been proposed for catheter ablation as first-line treatment of paroxysmal atrial fibrillation choice,namely without anti-arrhythmic medication directly to catheter ablation.The patients with persistent atrial fibrillation after repeated catheter ablation can successfully maintain sinus rhythm.The treatment of catheter ablation of atrial fibrillation can cure the vast majority of patients with atrial fibrillation,and shows the good prospects for treatment,and can improve the quality of life and clinical prognosis of patients.But there still exists certain recurrence after atrial fibrillation ablation,how to reduce the postoperative atrial fibrillation recurrence is also one of the hot spot of current research.The study that after converting atrial fibrillation and restoration of sinus rhythm,left heart function can't immediately returned to normal,the occurrence of this phenomenon may be due to invalid atrial contraction.After converting atrial fibrillation to sinus rhythm,transient mechanical dysfunction of left atrium and the left auricle happens,this phenomenon is called atrial suppression.Left atrial function drops can last several days to several months.The occurrence of atrial suppression has nothing to do with the way of converting atrial fibrillation.After radiofrequency ablation converting atrial fibrillation to sinus rhythm,the occurrence of this phenomenon is because radiofrequency ablation damages myocardial tissue and leads to increase of left atrial diameter(LA)and transient decline of left atrial ejection fraction(LAEF).With the increase of clinical postop-erative thromboembolic events,people pay attention to the mechanism research of atrial stunning.At present,the best clinical treatments of atrial stunning are: on the one hand is to improve myocardial atrial meal or restore its mechanical systolic or diastolic function as soon as possible,there are small-scale experiments proving that angiotensin II receptor antagonist can help the suppression of atrial muscle to restore its mechanical function as soon as possible,but still need to wait for large clinical trials to confirm.On the other hand is the anticoagulant therapy to prevent thrombosis and thromb-oembolic events,anticoagulant therapy continues to recover natural atrial mechanical function,but there are some bleeding risks during the anticoagulation,whichs are harm to the patients.After converting atrial fibrillation to sinus rhythm,therefore,how to effectively prevent and treat atrial stunning occurred,as soon as possible to improve recovery of left atrial mechanical function remains to be further studied.Current research suggests that atrial stunning may be related to inflammation of the atrial muscle cells.And the inflammatory response is an early recurrence of atrial fibrillation after catheter ablation of atrial fibrillation.After radiofrequency ablation of atrial fibrillation,the myocyte of the left atrial is destructed,which may affect the occurrence of atrial conduction function disorder and cause uneven of atrial muscle contraction.After radiofrequency ablation of atrial fibrillation in a period of time left atrial function decline,namely atrial suppression,which to a certain extent,affected therapeutic effect of the radiofrequency ablation of atrial fibrillation.The present study found that after radiofrequency ablation for atrial fibrillation can lead to the increase of myocardial injury markers in the human body.After radiofrequency ablation of atrial fibrillation,long time,due to the melting process of discharge frequency,range of melting process,large range of myocardial injury can lead to the rise of postoperative myocardial injury markers.A study showed degree of myocardial injury and inflammation after atrial fibrillation ablation present positive correlation.This study attempts to understand the inflammation after radiofrequency ablation of atrial fibrillation,myocardial injury markers,and the change trend of left atrial function and recovery time,further understand after radiofrequency ablation of atrial fibrillation the time and degree of suppression and the related factors of postoperative recurrence of atrial fibrillation.The study will set reasonable anticoagulation for patients after atrial fibrillation ablation to effectively prevent thromboembolism,reduce the cost of postoperative anticoagulation therapy and the occurrence of bleeding complications,and provide the theory basis for guiding the treatment of anticoagulation after atrial fibrillation ablation.The study consists of four parts: The first part is Left atrial function,inflammation,and prothrombotic response after radiofrequency ablation for atrial fibrillation.The second part is the effects on myocardial injury after radiofrequency ablation in patients with paroxysmal atrial fibrillation.The third part is inflammation and influence of early recurrence after radiofrequency ablation of atrial fibrillation.Part one Left atrial function,inflammation,and prothrombotic response after radiofrequency ablation for atrial fibrillationObjective: The conversion of atrial fibrillation(AF)to sinus rhythm is associated with transient dysfunction of the left atrium(LA).This study aimed to investigate the time course of LA function and inflammation after radiofrequency(RF)ablation for paroxysmal AF.Methods: Fifty-three patients with paroxysmal AF undergoing RF ablation were recruited.White blood cells were counted and high-sensitivity C-reactive protein(hs-CRP),fibrinogen,and D-dimer levels were measured.LA emptying fraction,strain,and strain rate were evaluated before RF ablation and at 7,14,21,and 28 days and 60 and 90 days after ablation using conventional Doppler echocardiography and two-dimensional speckletracking echocardiography.Results: Paroxysmal atrial fibrillation after radiofrequency ablation all inflammatory indexes compared with preoperative levels over time showed increasing trend(P < 0.05).After radiofrequency ablation in paroxysmal atrial fibrillation,coagulation index on postoperative day 3 to 7 days to reach the highest level.LA emptying fraction sharply decreased at day 7 after ablation and then slowly increased(P<0.05)and returned to the baseline value at day 28.LA strain and strain rate values sharply decreased at day 7 after the procedure and then slowly increased(P<0.05).A significant correlation between hs-CRP level and LA emptying fraction was found at day 7.Summary:1.Reduced LA function found at~1 week after AF ablation for paroxysmal AF and 1 month recover gradually.So after radiofrequency ablation of atrial fibrillation anticoagulation therapy need for at least 1 month.2.Increased inflammatory response and prothrombotic tendency were found at ~1 week after AF ablation for paroxysmal AF.Postoperative 1 week may be prone to thromboembolic events,anticoagulant therapy need to be improved.Part two The effects on myocardial injury after radiofrequency ablation in patients with paroxysmal atrial fibrillationObjective: After radiofrequency ablation of atrial fibrillation,the myocyte of the left atrial is destructed,but within a certain period of time after ablation changes of the myocardial injury markers is unclear.We aim to understand after radiofrequency ablation of atrial fibrillation and changing trends of postoperative myocardial injury markers of myocardial injury markers,in order to guide clinical treatment.Methods: Seventy-five patients aged less than 80 years,suffering from atrial fibrillation who underwent circumferential pulmonary vein isolation(CPVI)were enrolled.Peripheral blood samples were collected for creatinine kinase(CK),creatinine kinase-MB(CK-MB)and cardiac troponin I(c TnI)before the operation and at 7,14 days after the operation.Continuous monitoring was performed for 3 days after the ablation.Outpatients follow-up were scheduled at 1,2,3,4 weeks and 2,3 months after procedure.Patients were monitored with an ECG and 48-hour ambulatory electrocardiogram recordings(Holter)was performed twice a month to determine the presence of recurrent arrhythmias at each visit performed at one months and more after ablation.Recurrence of atrial fibrillation is defined as any atrial arrhythmia lasting more than 30 seconds.Early recurrence was defined atrial arrhythmia lasting more than 30 seconds within 3 months after atrial fibrillation ablation with an ECG and 48-hour ambulatory electrocardiogram recordings(Holter).Results: After radiofrequency ablation of atrial fibrillation,CK before the operation and at 1,2,3,7 days,14 days after the operation was statistically significant(P<0.05),compared with preoperative levels,which showed firstly the rise and declined gradually.1 days after operation increased significantly and reached the peak,the difference was statistically significant(P<0.05),then 2,3 days gradually declined,3 days recovered to preoperative levels.CK-MB before the operation and at 1,2,3,7 days,14 days after the operation was statistically significant(P<0.05),compared with preoperative levels,which showed firstly the rise and declined gradually.1 days after operation increased significantly and reached the peak,the difference was statistically significant(P<0.05),then 2,3 days gradually declined,3 days recovered to preoperative levels.CTnI before the operation and at 1,2,3,7 days,14 days after the operation was statistically significant(P<0.05),compared with preoperative levels,which showed firstly the rise and declined gradually.1 days after operation increased significantly and reached the peak,the difference was statistically significant(P<0.05),then 2,3 days gradually declined,7 days recovered to preoperative levels.14 days after the operation gradually decline,have not statistically significance(P> 0.05).Summary: After radiofrequency ablation for paroxysmal atrial fibrillation,there is mild myocardial injury,the CK,CK-MB and cTnI elevated postoperative 3 days and then reached their peak,gradually declined after 7 days.Part three Inflammation and influence of early recurrence after radiofrequency ablation of atrial fibrillationObjective: The emergence of catheter radiofrequency ablation for clinical treatment provides a new method of curing atrial fibrillation,but postoperative recurrence rate of atrial fibrillation is too high,which is the main problems of catheter radiofrequency ablation.In recent years,inflammation effect on recurrence of atrial fibrillation after cardiac surgery causes a lot of attention.This study aimed to investigate the inflammation changes after radiofrequency ablation of atrial fibrillation with influence of early recurrence.Methods: Ninety consecutive patients aged less than 80 years,suffering from atrial fibrillation who underwent circumferential pulmonary vein isolation(CPVI)were enrolled,including 53 patients with paroxysmal atrial fibrillation(atrial fibrillation lasting less than 7 days),37 patients with persistent atrial fibrillation(atrial fibrillation lasting more than 7 days).Peripheral blood samples were collected for hypersensitive c-reactive protein,fibrinogen,creatine kinase isoenzyme and troponin I before the operation and at 7,14 days after the operation.Continuous monitoring was performed for 3 days after the ablation.Outpatients follow-up were scheduled at 1,2,3,4 weeks and 2,3 months after procedure.Patients were monitored with an ECG and 48-hour ambulatory electrocardiogram recordings(Holter)was performed twice a month to determine the presence of recurrent arrhythmias at each visit performed at one months and more after ablation.Recurrence of atrial fibrillation is defined as any atrial arrhythmia lasting more than 30 seconds.Early recurrence was defined atrial arrhythmia lasting more than 30 seconds within 3 months after atrial fibrillation ablation with an ECG and 48-hour ambulatory electrocardiogram recordings(Holter).Results: After radiofrequency ablation of atrial fibrillation,Hs-CRP before the operation and at 1,2,3,7 days,14 days after the operation was statistically significant(P<0.05),compared with preoperative levels,which showed a trend of increasing with time.2,3 days after operation increased significantly and reached peak value,the difference was statistically significant(P<0.05).Hs-CRP gradually decline at 7 and 14 days after the operation,but still have statistically significance(P<0.05).Fibrinogen levels before the operation and at 1,2,3,7 days,14 days after the operation was statistically significant(P<0.05),compared with preoperative levels,which showed firstly the rise and declined gradually.2,3 days and 7 days after operation increased significantly and reached peak value,the difference was statistically significant(P<0.05),Fibrinogen gradually decline at 14 days after the operation,have not statistically significance(P>0.05).CK-MB before the operation and at 1,2,3,7 days,14 days after the operation was statistically significant(P<0.05),compared with preoperative levels,which showed firstly the rise and declined gradually.1 days after operation increased significantly and reached peak value,the difference was statistically significant(P < 0.05),then 2,3 days gradually declined,3 days recovered to preoperative levels.CK-MB gradually decline at 7 and 14 days after the operation,have not statistically significance(P>0.05).CTnI before the operation and at 1,2,3,7 days,14 days after the operation was statistically significant(P<0.05),compared with preoperative levels,which showed firstly the rise and declined gradually.1 days after operation increased significantly and reached peak value,the difference was statistically significant(P<0.05),then CTnI gradually declined at 2,3 days,at 7 days recovered to preoperative levels.14 days after the operation gradually decline,have not statistically significance(P>0.05).Multiariable Logistic regression analysis results show the Hs-CRP elevation(OR = 2.864,95% CI: 1.493 5.493,P = 0.002)was independent risk factor for early recurrence of atrial fibrillation.Summary:1.Increased inflammatory response and prothrombotic tendency were found at ~1 week after atrial fibrillation ablation for atrial fibrillation.2.After atrial fibrillation ablation for atrial fibrillation,myocardial injury was found three days before.3.Atrial fibrillation after radiofrequency ablation the extent of Hs-CRP levels elevation is the independent risk factor for early recurrence of atrial fibrillation.Conclusions:1.Increased inflammatory response and prothrombotic tendency were found at ~1 week after AF ablation for paroxysmal AF.Postoperative 1 week may be prone to thromboembolic events,anticoagulant therapy need to be improved.2.Reduced LA function found at~1 week after AF ablation for paroxysmal AF and 1 month recover gradually.So after radiofrequency ablation of atrial fibrillation anticoagulation therapy need for at least 1 month.3.After radiofrequency ablation for paroxysmal atrial fibrillation,there is mild myocardial injury,the CK,CK-MB and cTnI elevated postoperative 3 days and then reached their peak,gradually declined after 7 days.4.Atrial fibrillation after radiofrequency ablation the extent of Hs-CRP levels elevation is the independent risk factor for early recurrence of atrial fibrillation. |
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