The Analysis Of The Late Recurrent Predictors Of Atrial Fibrillation After Radiofrequency Catheter Ablation

Background:Atrial fibrillation is one of the most common clinically cardiac arrhythmia, which could significantly increase the rate of cardiovascular events and mortality,and its prevalence has increased during the past few decades.Medical science and technology are rapidly developing,the technology of radiofrequency catheter ablation has appeared one of the main treatments of atrial fibrillation.Recent studies have identified that radiofrequency catheter ablation(RFCA)basing on pulmonary veins isolation(PVI) are all effective treatments,specially for paroxysmal atrial fibrillation(PAF),RFCA is the treatment that intervene the matrix,and the safety and efficacy have been confirmed by a lot of studies. There is a recurrence rate after radiofrequency catheter ablation, and different centers reported mixed results. To reduce recurrence rate and investigate the recurrent predictors are significant for clinicians to identify patients and choose appropriate treatment strategy.Objective:The purpose of this study is to evaluate the recurrence rate and investigate the predictive factors of late recurrence of paroxysmal atrial fibrillation( PAF) after radiofrequency catheter ablation.Methods:In this study, 136(79 males,57 females; mean age,60.10±9.47years) patients with paroxysmal atrial fibrillation who underwent radiofrequency catheter ablation guided by 3-dimensional mapping system at our medical center from April 2009 to December2013 were consecutively enrolled. The clinical dates( age, duration of atrial fibrillation,clinical biochemical index,12-lead electrocardiogr- am,echocardiogram,etc)before ablation were recorded, and systematic follow-up was conducted after ablation.Electrocardiography or 24-hour Holter monitoring was performed in these patients in 3, 6, 9, and 12 months after ablation.Atrial fibrillation recurrence was monitored and defined as any registration of atrial fibrillation on electrocardiogram or an episode of atrial fibrillation or atrial tachycardia longer than 30 seconds on 24-hour Holter monitoring.136 cases of paroxysmal atrial fibrillation were divided into recurrence group(n=44) and no recurrence group(n = 92) according to clinical manifestations and electrocardiographic results.Then univariate analysis was carried out.Multivariate Logistic regression was carried out to the parameters that P<0.1 in the univariate analysis to determinate the related factors of late recurrence.Statistical analysis was performed with SPSS17.0.Result:All patients meet ablation endpoint.Within the follow-up period of 12 months,44 patient experienced late recurrence,92 patients maintained sinus rhythm, the recurrence ratio is 32.4%. Univariate analysis shows that BMI(25.82±3.02 vs.24.60±2.61,P=0.017),left atrial maximal volume index(42.42±14.81 vs.35.52±8.98,P=0.007),left atrial presystolic volume index(32.22±13.13 vs.26.60±8.25,P=0.012),left atrial minimal volume index(24.43±12.42 vs.17.40±6.89,P=0.001),left atrial active emptying fraction(25.66±14.45vs35.54±13.285,P < 0.001),left atrial total emptying fraction(44.09±13.29vs51.82±12.83,P=0.001),type of f-wave(21/23 vs.65/27,P=0.009)were significantly different.Multivariate logistic regression is carried out to the parameters that P<0.1 in the univariate analysis. The results reveals that BMI(OR=1.212,95%CI=1.033~1.424,P=0.019)and type of f-wave(OR=2.941,95%CI=1.233~7.014,P=0.015) are independent predictors of late recurrence.Conclusion:The results shows that the rate of late recurrence after radiofrequency catheter ablation of paroxysmal atrial fibrillation is about 32.4%.BMI,left atrial maximal volume index,left atrial presystolic volume index,left atrial minimal volume index,left atrial active emptying fraction,left atrial total emptying fraction and type of f-wave are significantly different in two groups. BMI and type of f-wave are independent predictors of the late recurrence of paroxysmal atrial fibrillation after radiofrequency ablation.