The Effect Of Tricuspid Regurgitation On The Recurrence After Minimally Invasive Surgical Radiofrequency Ablation

Background Atrial fibrillation is the common clinical arrhythmia,which often leads to a variety of complications including the thrombosis and heart failure.The minimally invasive radiofrequency ablation for atrial fibrillation has become a new and effective method for the treatment of atrial fibrillation.Most patients of atrial fibrillation combine with different degrees of tricuspid regurgitation,but the research on the influence factors of recurrence after ablation is rarely concentrated in the tricuspid regurgitation.Analysis of tricuspid regurgitation on factors of recurrence after minimally invasive radiofrequency ablation for atrial fibrillation could help to assess the prognosis of atrial fibrillation.Objective Evaluate the effects of minimally invasive surgical ablation for the postoperative recurrence,thus to help and guide the clinical diagnosis and treatment for patients with atrial fibrillation.Methods This study selected 107 patients combined with tricuspid regurgitation from January 2011 to January 2015 in the cardiothoracic department of Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine,for the first time minimally invasive surgical radiofrequency ablation to treat atrial fibrillation.Collect the clinical data of the patients,including age,sex,type of atrial fibrillation,duration of atrial fibrillation.Record the preoperative echocardiography,including instantaneous tricuspid regurgitation,right atrial diameter,and left atrial diameter.The postoperative follow-up is by telephone and consultation,including 1,3,6,12 months after discharge,and afterwards every year,through 24 h dynamic electrocardiogram examination,ECG,and the symptoms of patients,evaluate the maintenance of sinus rhythm after the surgery.Cox regression analysis was used to evaluate the effect of preoperative tricuspid regurgitation on the recurrence of atrial fibrillation after radiofrequency surgical ablation.Results Among the 107 atrial fibrillation patients with tricuspid regurgitation,there were 79 patients with mild tricuspid regurgitation and 28 patients with moderate tricuspid regurgitation,the mean tricuspid regurgitated flow is 7 + 2.9 ml.According to the preoperative echocardiography,left atrial anteroposterior diameter is 42.6 +.5.9 mm,and right atrial left-right diameter is 40.6 +.3.8 mm.All patients were followed up for more than 12 months,and the average follow-up time was 3.4 + 1.6 years.During the follow-up period,13 patients presented with recurrent atrial fibrillation,and the remaining 94(87.8%)maintained sinus rhythm.Using multivariate Cox regression analysis to study the factors affecting the recurrence of atrial fibrillation after minimally invasive surgical radiofrequency ablation,the results showed that,preoperative tricuspid regurgitated flow;preoperative right atrial left-right diameter and preoperative left atrial anteroposterior diameter are the important risk factors.According to the ROC,the cut-off value of right atrial diameter was 44 mm,and the sensitivity of predicting was 46.15%,the specificity was about 89.36%.The cut-off value of the tricuspid regurgitation was 8ml,and the sensitivity of predicting was 61.54%,the specificity was 78.72%.According to the survival of Kaplan-Meier analysis,we found that,the patients with right atrial diameter in the preoperative cardiac ultrasound examination less than or equal to 44 mm,have a longer time of sinus rhythm after the ablation,than those with right atrial size greater than 44 mm.The Log Rank test results also support the discovery,the p value is less than 0.05 with statistical significance.In the patients with tricuspid regurgitation flow less than or equal to 8ml,the postoperative maintenance of sinus rhythm was significantly better than those with tricuspid regurgitation greater than 8ml,the Log Rank test results support the discovery,the p value is less than 0.05.Conclusion Preoperative tricuspid regurgitation,right atrial size and left atrial size were the independent risk factors of recurrence in patients with atrial fibrillation after minimally invasive surgical radiofrequency ablation,having important clinical significance for predicting postoperative recurrence of atrial fibrillation.