| Objective: Atrial fibrillation(AF) is a common arrhythmia in clinical practice. Many studies have shown that in a period of time after cardioversion of AF there is a risk of embolism, and the reason is related to atrial stunning and atrial dysfunction after restoration of sinus rhythm. Radiofrequency catheter ablation has become an advanced interventional surgery for atrial fibrillation in recent years, and it is an effective method to cure AF and has attracted extensive patients with atrial fibrillation. However, as atrial stunning and the left atrial dysfunction persist after radiofrequency ablation of atrial fibrillation, they affected the therapeutic effect of radiofrequency ablation of atrial fibrillation. However, mechanisms of atrial stunning, how to reduce the occurrence of atrial stunning and improve left atrial function after radiofrequency ablation of AF have become a hot research at home and abroad, and there is no clear conclusions. Accumulating data suggest that inflammation as well as oxidative stress is an important feature involved in the development and persistence of AF, and atrial stunning may be related to atrial myocytes of inflammation, oxidative stress, myocardial fibrosis and so on. As statins became more widely used, their effects beyond lipid lowering began to emerge, these so-called "pleiotropic ", such as anti-inflammatory antioxidants, improve cardiac remodeling, and anti-myocardial fibrosis and so on. Therefore, our study aims to compare the changes of left atrial function and atrial stunning after radiofrequency ablation of AF in statin group and non-statin group, with atorvastatin calcium selected in the statin group, observing whether it can improve the function of the left atrial and reduce the occurrence of atrial stunning after radiofrequency ablation. Mechanisms and specific time of atrial stunning after radiofrequency ablation are also explored in this study. The study can provide a basis for clinical treatment of atrial fibrillation.Method: The subjects of the study were the hospitalized patients with atrial fibrillation(AF) and fitting line of radiofrequency ablation surgery at the Second Hospital of Hebei Medical University between December 2013-January 2015. The AF patients included persistent AF patients and paroxysmal AF patients, a total of 49 cases. Patients were divided into statin and non-statin group randomly. Statin group: conventional treatment of AF and atorvastatin calcium(Pfizer medicine) 20 mg orally 1/night 3 to 4 days prior to surgery; non-statin group: conventional treatment of AF. All patients before treatment need history taking, physical examination, laboratory tests, electrocardiogram(ECG) and holter, transesophageal echocardiography(TEE) and other preoperative examination. Radiofrequency ablation surgery was performed by the same surgeon, and an unified operation method: circumferential pulmonary vein isolation(CPVI) is used. If special circumstances occurred, such as surgery need to be changed, the subjects should be excluded from this study. Atrial stunning and left atrial function indices were measured by echocardiography before and after radiofrequency ablation surgery at 1 week, 2 weeks, 3 weeks and 4 weeks. Data were processed with SPSS 13.0 software. When data are subject to normal distribution, continuous variables were expressed as the mean ± standard deviation, if not, the variables were expressed as the median and quartile. Groups were compared using repeated measures mixed model lines. Means were compared using t test. P value of <0.05 was considered statistically significant.Results: Atrial radiofrequency ablation were successfully completed in the whole patients. The surgical procedures are circumferential pulmonary vein isolation. No pulmonary vein stenosis, thromboembolic events, cardiac tamponade, left atrial esophageal fistula and other complications occurred in the subjects. 1 The general situation in two groups The non-statin group of patients: males 18 and females 10; paroxysmal atrial fibrillation 19 cases and permanent atrial fibrillation 9 cases; the statin group of patients: males 14 and females 7; paroxysmal atrial fibrillation 14 cases and permanent atrial fibrillation 7 cases. 2 Echocardiographic indices: 2.1 Left atrial structure indices: Left atrium diameter(LAD): there was no significant difference in preoperative, 1 week, 2 weeks, 3 weeks, and 4 weeks after radiofrequency ablation surgery(P>0.05); there was no significant difference between the non-statin group and the statin group(P>0.05). 2.2 Heart function indices: 2.2.1 Left atrial ejection fraction(LAEF%): in statin group, 1 week, 2 weeks after radiofrequency ablation surgery was significantly lower than the preoperative(P<0.05), 3 weeks after radiofrequency ablation surgery was no significant difference compared with preoperative(P>0.05), and the 4 weeks was significantly higher than preoperative(P<0.05);in non-statin group, 1 week, 2 weeks, 3 weeks after radiofrequency ablation surgery were significantly lower than the preoperative(P<0.05), and the 4 weeks was significantly higher than preoperative(P<0.05); the LAEF% after radiofrequency ablation in statin group is higher than that in non-statin group(P<0.05). 2.2.2 A peak: Difference between the groups was statistically significant(P<0.05), the A peak after radiofrequency ablation surgery has a tendency to increased gradually, and after radiofrequency ablation in statin group is higher than that in non-statin group(P<0.05). 2.2.3 E peak: there was no significant difference in preoperative, 1 week, 2 weeks, 3 weeks, and 4 weeks after radiofrequency ablation surgery(P>0.05); there was no significant difference between the non-statin group and the statin group(P>0.05). 2.2.4 E/A: Difference between the groups was statistically significant(P<0.05), the comparison between the non-statin group and the statin group was no significant differences(P>0.05). 2.2.5 A peak velocity time integral(A-VTI):there was no significant difference in preoperative, 1 week, 2 weeks, 3 weeks, and 4 weeks after radiofrequency ablation surgery(P>0.05); there was no significant difference between the non-statin group and the statin group(P>0.05). 2.2.6 e’: there was no significant difference in preoperative, 1 week, 2 weeks, 3 weeks, and 4 weeks after radiofrequency ablation surgery(P>0.05); there was no significant difference between the non-statin group and the statin group(P>0.05). 2.3 Left atrial strain indices: 2.3.1 Left atrial strain(S): there were no significant differences in preoperative, 1 week, 2 weeks, 3 weeks, and 4 weeks after radiofrequency ablation surgery(P>0.05); the GS after radiofrequency ablation in statin group is higher than that in non-statin group(P<0.05). 2.3.2 Left atrial strain rate(SR) 2.3.2.1 Left ventricular systolic(SRs): there were no significant differences in preoperative,1 week, 2 weeks, 3 weeks, and 4 weeks after radiofrequency ablation surgery(P>0.05); the SRs after radiofrequency ablation in statin group is higher than that in non-statin group(P<0.05). 2.3.2.2 Left ventricular diastolic early(SRe): there was no significant difference in preoperative, 1 week, 2 weeks, 3 weeks, and 4 weeks after radiofrequency ablation surgery(P>0.05); there was no significant difference between the non-statin group and the statin group(P>0.05). 2.3.2.3 Left atrial systolic(SRa): there was no significant difference in preoperative, 1 week, 2 weeks, 3 weeks, and 4 weeks after radiofrequency ablation surgery(P>0.05); there was no significant difference between the non-statin group and the statin group(P>0.05). 3 The correlation analysis results of left atrial function and age, left atrial diameter(LAD), whether the use of statins, plasma low-density lipoprotein(LDL- c): LAEF: postoperative 1 week is associated with LAD and whether the use of statins(P<0.05); postoperative 2 week,3 week,4 week are only associated with LAD(P<0.05);A peak: postoperative 1 week is associated with LAD and age(P<0.05); postoperative 3 week and LAD, age, whether the use of statin, plasma low-density lipoprotein(LDL- c) are not related; postoperative 4 week is associated with LAD and age(P<0.05).Conclusions: 1 After radiofrequency ablation of atrial fibrillation atrial stunning occurred,and the most obvious one week after surgery, therefore anticoagulant is necessary, postoperative week 1 is the most important. 2 Atrial stunning and left atrial disfunction lasted about 4 weeks after radiofrequency ablation of atrial fibrillation in non-statin group, so at least 4 weeks of anticoagulant was needed. 3 Atrial stunning and left atrial disfunction lasted about 4 weeks after radiofrequency ablation of atrial fibrillation in non-statin group, so at least 4 weeks of anticoagulant was needed, and after 1 week, 2 week, 3 week, 4 week left atrial ejection fraction improved. 4 Atorvastatin calcium can improve the left atrial function and shorten the time of atrial stunning after radiofrequency ablation of atrial fibrillation. |
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