The Study Of Thromboembolism For The Atrial Fibrillation Patients Who Have Accepted Catheter Ablation Therapy And Have A Long-term Success

Objective: We analyzed the thromboembolism of the atrial fibrillation includingparoxysmal atrial fibrillation and persistent artrial fibrillation who have acceptedcatheter ablation therapy and have a long-term success in this study. Through this studywe want to know the thromboembolism of the operative long-term successful atrialfibrillation patients and the relationship with the CHA₂DS₂-VASCscore.Methods: From January2000to May2009,364consecutive patients withdrug-refractory paroxysmal and persistent AF underwent catheter ablation and werefollowed up for （60.7±11.8） months.Among them paroxysmal AF patients underwentcircumferential bilateral pulmonary vein linear ablation guided by Lasso lead and Cartotechnique to bilateral pulmonary vein completely ablated.Except for bilateral pulmonaryvein linear ablation guided by Lasso lead and Carto technique to bilateral pulmonaryvein completely ablated,Persistent AF patients underwent additionally ablation with leftatrial top,left atrial isthmus, right atrial isthmus,CS intima and so on to sinus rhythm.Ifstill no change for sinus rhythm from these ablation,the patients underwentcardioversion.After ablation the patients examined routinely with ECG,24h-holter,andat the one month,three month,six month,one year after ablation examined24h-holter toknow recurrence or not.Long-term after ablation（2years or above） the patients werefollowed up with24-holter,ECG,telephone or letter.And we record whether AFrecurrent or not,whether the patient have embolization and the anticoagulation.Results:（1）There were43patients lost to follow up.In the remaining321patients,261cases were paroxysmal AF and60cases were persistent AF.Sinus rhythm was maintained in204patients[134males,（56.7±11.6） years old] and AF recurrenceevidenced in117patients.In Group Sinus,178cases were paroxysmal AF;26cases werepersistent AF;4cases suffered from cerebral embolism and3patients[CHA₂DS₂-VASCscores were respective3,4,7] continued to take warfarin but didnot suffer fromembolism.In Group recurrence,20patients continued to take warfarin;9cases sufferedfrom cerebral embolism.The long-term success rate of catheter ablation is63.6%.Toparoxysmal AF and persistent AF,the success rate of catheter ablation is respectively68.2%and43.3%.（2）The incidence of embolism event in Group sinus is obvious lower than inGroup recurrence（P=0.017）.（3）In group sinus,the incidence of embolism event in the CHA₂DS₂-VASC＜2patients were lower than in the CHA₂DS₂-VASC≥2patients（P=0.023）.（4）In group recurrence, the incidence of embolism event in the CHA₂DS₂-VASC＜2patients were also lower than in the CHA₂DS₂-VASC≥2patients（P=0.041）.（5）The embolism event of the CHA₂DS₂-VASC＜2patients in group sinus islower than in the CHA₂DS₂-VASC＜2patients in group recurrence（P=0.029）.（6）The embolism event of the CHA₂DS₂-VASC≥2patients in group sinus vs theCHA₂DS₂-VASC≥2patients in group recurrence,the later has a high embolismtendency.But it doesnot reach to the statistical standards（P=0.054,near to0.05）.（7）The embolism event in group sinus aren,t relevant to the type of AF,the timesof ablation and the size of left atrial before ablation.Conclusion:（1）The embolism risk can be reduced obviously in long-term stable sinus rate aftercatheter ablation.（2）The CHA₂DS₂-VASCscore may have certain clinical significant in evaluationthe embolism risk of recurrent and success patients after AF ablation.The higher thescore,the higher may the incidence emblization.（3）In the long-term stable sinus after AF ablation,for the patients CHA₂DS₂-VASC＜2points may be relative safety to stop anticoagulating and for the patientsCHA₂DS₂-VASC≥2points,to be on the safe side,are suggested to continueanticoagulating.（4） The type of AF,the times of ablation and the size of left atrial before ablationmay not be main indicator to forecasting embolism risk of the long-term sustain sinuspatients after ablation.