To Investigate The Relationship With Inflammatory Factors And Prognosis After Different Ablation Methods

ObjectivesThree different ablation methods were observed for the treatment of paroxysmal atrial fibrillation in the treatment of non-pressure catheter radiofrequency ablation,generation of cryosaccharide ablation and second generation cryotherapy.Observe the pressure catheter radiofrequency ablation and the second generation of frozen balloon ablation perioperative myocardial damage markers and a variety of inflammatory factor dynamic change,explore myocardial injury markers and related inflammatory factor levels relationship with prognosis of paroxysmal atrial fibrillation and its influencing factors.MethodsThis study was included in 223 cases of non-valvular paroxysmal atrial fibrillation patients who underwent cryoablation or radiofrequency ablation at the chest hospital of tianjin from September 2015 to June 2017.Of patients eligible for inclusion,preoperative full told the pros and cons of various way of melting,benefit,effectiveness,and safety by patients voluntarily chooses the ablation mode,the selected for a generation of frozen balloon ablation group?CB-1 group?,the second generation of frozen balloon ablation group?CB-2 group?and catheter radiofrequency ablation?RF?.In the three groups,the anticoagulant therapy was determined according to the thrombosis risk?CHA₂DS₂-VASc score?.All selected patients with preoperative routine thoracic echocardiography?TTE?,it moves to evaluate cardiac function and heart structure,conventional line heart strengthen CT examination in the left atrial thrombus clear situation,left atrial and pulmonary vein structure,such as enhanced CT suspicious left the room or left auricle thrombus,then again through the esophagus cardiac figure?TEE?except left Fang Kehang or left auricle thrombus ablation surgery.Before ablation,immediately after operation,postoperative 24 hours and 72 hours after extraction was fasting venous blood,using automatic blood cells,biochemical analyzer,analysis of creatine kinase?CK?,creatine kinase isoenzyme?CK-MB?,hypersensitive c-reactive protein?hsCRP?assay index,etc.Serum interleukin 1 beta?IL-1??,interleukin-6?IL-6?and interleukin 10?IL-10?,7interleukins?IL-7?and interleukin-6 free receptor?sIL-6R?analysis of the testing using enzyme-linked immunosorbent assay?ELISA?method.All selected cases were recorded into Microsoft Office Access 2016 software to establish a follow-up database.Patients were followed up with regular follow-up and follow-up.Patients in postoperative 1 week,1 month,3 months,6 months,9 months,12 months regular follow-up,follow-up include symptoms described,routine 12-lead electrocardiogram,24-hour dynamic electrocardiogram.The patient was told to have a concurrent electrocardiogram examination.Atrial fibrillation ablation success is defined as the ablation for 3 months?90 days?blank after conventional electrocardiogram or 24hours dynamic electrocardiogram in the absence of more than 30 seconds of atrial fibrillation and flutter speed or room,for this study namely primary efficacy end point events.The differences in prognosis of patients with atrial fibrillation were observed during the follow-up period and their correlation with the dynamic changes in the markers of inflammatory mediators and myocardial injury.All data were statistically processed using IBM SPSS Statistics v19.0 statistical software.The results were denoted by mean plus or minus standard deviation.All data were tested in normal state.Among the three groups,one-way ANOVA,myocardial injury markers and dynamic changes of inflammatory factors were used to analyze multivariate ANOVA with repeated measurements.The separate effect analysis is based on the paired t test method based on local adjustment standard error.P<0.05 was considered statistically significant.Kaplan-meier curve was used to describe the recurrence rate of non-atrial fibrillation,and Log Rank test was used for survival curves.The Cox proportional risk model was used to calculate the patient's recurrence,and the effect of the treatment modality,myocardial injury markers and the level of inflammatory factors on the risk of recurrence was observed.Results1.Basic information and professional information of patients.A total of 223 patients were enrolled in the study,88 were selected as RF group,52 were selected as CB-1group,and 83 were selected as CB-2 group.The gender,age,history,bleeding and stroke score,left atrial diameter and left ventricular ejection fraction of the three groups were not statistically significant?P<0.05?.2.Operation and prognosis.In addition,there were 4 cases in the CB-1 group and 1case in the CB-2 group.There was 1 case in which a pulmonary vein potential was not completely isolated after the ablation of the catheter after ablation.The immediate pulmonary vein isolation rate was 100%in the remaining patients.The duration of the operation and the ablation duration of the RF group>CB-1 group were statistically significant?P<0.05?.The radiographic exposure duration and the exposure amount of the RF group<CB-2 group<CB-1 group were statistically significant?P<0.05?.There was one case of phrenic nerve palsy?PNP?in both CB-1 and CB-2 groups,and the transient reversible phrenic nerve palsy.In the RF group,there was one case of pericardial tamping after the operation,and the pericardial puncture and drainage was performed in a timely manner,and the condition was stable and gradually improved.There was no statistical difference between the three groups?P<0 0.05?.Among the 223 patients,12 were lost,and 211 cases were effectively followed up,and the median follow-up time was 349 days.Kaplan-meier survival analysis,the success rate of atrial fibrillation ablation in the 12th month was higher than that in the RF group and CB-1 group?83.1%vs.69.3%vs.67.3%,Log Rank P<0.05?.3.Comparison of the markers of myocardial injury and the level of inflammatory factors in the RF group and CB-2 group.There was no statistically significant difference between the two groups in preoperative myocardial injury markers and inflammatory factor baseline?P<0.05?.CK and CK-MB levels varied with the time factor?i.e.,immediate postoperative,24 hours after surgery,and 72 hours after surgery?.The levels of CK and CK-MB were significantly higher than that of the RF group,and the difference was statistically significant?P<0.05?.In the 72 hours after the operation,both the RF group and the CB-2 group CK and CK-MB level dynamic change trend showed the first increase and then decreased,and the return to the preoperative level was reduced.The levels of hsCRP,IL-1,IL-6,IL-10,IL-7 and sIL-6R were not related to the group under the action of time factors,and the overall dynamic change trend of the two groups was roughly the same.After 24 hours and 72hours after surgery,the levels of inflammatory factors were higher than those in the RF group,and the difference was statistically significant?P<0.05?.4.The relationship between the clinical data,the marker of myocardial injury and the level of inflammatory factors and the recurrence of atrial fibrillation in the CB-2group and the RF group.Through the Pearson correlation analysis found that immediate postoperative CK,CK-MB level,after 24 hours of CK,CK-MB,hsCRP,IL-6,IL-10,sIL-6R level and 72 hours after CK-MB,hsCRP,IL-17,IL-10,sIL-6R level associated with the melting method?P<0.05?,CB-2 group higher than that of the RF group,and the difference was statistically significant?P<0.05?.Cox regression analysis found that the survival of treatment for the independent factors influencing the recurrence of atrial fibrillation?P=0.038?,and the pressure conduit compared thermal ablation?RF?,using the second generation of frozen balloon ablation group?CB-2?catheter ablation of atrial fibrillation recurrence rate is lower than the pressure,relative risk HR=0.505,HR?95%CI?,CI=0.265-0.963.Conclusions1.For the ablation of paroxysmal atrial fibrillation,a generation of cryogenic balloon ablation is comparable to that of non-pressure catheter radiofrequency ablation,and the efficacy is not inferior to that of non-pressure catheter radiofrequency ablation;The efficacy and safety advantages of the second generation cryogenic balloon ablation and the radiofrequency ablation of the non-pressure catheter were obvious.2.Perioperative myocardial injury markers significantly different,the different methods of melting and the second generation of frozen balloon ablation catheter ablation is significantly higher than the level of myocardial enzyme pressure,myocardial enzyme dynamic change trend was showed to now reduce after increased first,and lower back to preoperative levels.HsCRP in perioperative inflammatory markers,interleukin,etc the dynamic change of level,and the choice of treatment,using the second generation of frozen balloon ablation related inflammatory factor levels higher than the use of pressure pipe hot melting.3.Myocardial injury markers,and inflammatory factor levels and paroxysmal atrial fibrillation recurrence of postoperative atrial fibrillation has no relevance for paroxysmal atrial fibrillation ablation,treatment for the independent factors influencing the recurrence of atrial fibrillation.Compared with non-pressure catheter ablation,the atrial fibrillation recurrence rate was lower than that of non-pressure catheter ablation.