The Impact And The Possible Mechanism On The Recurrence Of Atrial Fibrillation After Catheter Ablation In Patients With Metabolic Syndrome

Catheter ablation of atrial fibrillation(AF) has become first-line clinical treatment. Although now there are still some controversial sounds about the catheter ablation strategies and operation methods, pulmonary vein isolation(PVI) is the foundation of catheter ablation of AF. Even performing the PVI in combination with other ablation strategies, recurrence of atrial fibrillation is still a serious problem, which attributes to the unclear mechanism of atrial fibrillation. But there is no denying that the types of atrial fibrillation, duration and other basic diseases etc, really have a certain influence on the recurrence of atrial fibrillation. In recent years, metabolic syndrome(MS) is often mentioned, which is an integrated state of diseases including the hypertension, hyperlipidemia, obesity, diabetes and so on. For these patients, the abnormalities of blood pressure, blood lipid, blood glucose may play a role in changes of atrial electrical dissection structure through blood volume, atrial wall pressure, activation of the renin-angiotensin- aldosterone system, myocardial tissue fibrosis, myocardial tissue fatty infiltration function, and finally influence the effectiveness of catheter ablation in patients with atrial fibrillation. For this study we want to explore the impact and possible mechanism of metabolic syndrome to atrial fibrillation recurrence after catheter abaltion by using an objective, scientific and statistical methods to analyze the previous cases data, and finally find some specific diseases, which have larger influence on the recurrence of atrial fibrillation, to improve and guide the choice of clinical treatment.Part 1: The influence of metabolic syndrome to atrialfibrillation recurrence after catheter ablation ObjectiveIn this study we retrospectively analyzed those patients’ clinical and follow-up datas, who were scheduled for catheter ablation in Department of Cardiology of Tangdu Hospital from November 2012 to February 2014. Analysis the impact of the recurrence of atrial fibrillation after catheter ablation in patients with metabolic syndrome. We hope to find several metabolic diseases which have more influence to the recurrence of atrial fibrillation. Methods1. During the period between November 2012 and February 2014, 126 patients with AF were scheduled for catheter ablation in Department of Cardiology of Tangdu Hospital. They were enrolled and grouped by whether have got a preoperative diagnosis--metabolic syndrome in this study. We collected 107 patients’ basic clinical and follow-up datas, excluded 19 patients who were lost to follow-up. All the patients were grouped according to whether the patients with metabolic syndrome. At the same time depending on the type of atrial fibrillation the patients were divided into paroxysmal AF group and persistent AF group.2. All of the patients underwent left atrial CTA, transesophageal echocardiography, blood coagulation, liver and kidney function, blood routine, blood glucose, blood lipid, blood pressure and other related indicators. Circumferential PVI was performed at En Site 3000 Navx three-dimensional electrophysiological measurement system for all patients. Ablation end point was stop atrial fibrillation to sinus rhythm, or completed of all the preset ablation lines. If atrial fibrillation still not terminated, use heart cardioerter technique.3. The 3rd, 6th, 12 th after ablation we collected the follow-up datas by phone and outpatient follow-up, which includes:(1) recurrence of rapid atrial arrhythmia;(2) an arrhythmia-related 12-lead electrocardiogram(ECG) or a 24-h holter recording;(3) relevant biochemical inspection;(4) cardiac ultrasound.4. Analyzed with SPSS 13.0 statistics software. Measurement datas used mean +/-standard deviation, represented by two independent samples t-test. The count datas used the percentage(%), represented by chi-square test. To compare the recurrence rate between metabolic syndrome group and non-metabolic syndrome group use Kaplan Meier analysis. On the influence factors of recurrence of atrial fibrillation build Cox multivariate regression model, to evaluate the independent role of metabolic syndrome on the recurrence of atrial fibrillation. With bilateral test P<0.05 for the difference is significant. Results1. Baseline datas comparison: metabolic syndrome groups in gender, history of medicine, the proportion of persistent AF and left atrial diameter are significantly higher than patients without metabolic syndrome(P < 0.05); The rest indicators have no significant differences between the two groups(P>0.05). Associated with the metabolic syndrome diagnostic indicators(such as BMI, hypertension, hyperlipidemia, diabetes, etc.) are significant differences between the two groups(P < 0.05). The proportion of paroxysmal atrial fibrillation combined with metabolic syndrome was significantly lower than the other group(52.6%).2. Recurrence comparison: till 12 th after surgery, a total of 24 cases of recurrence, 12 cases of metabolic syndrome group, the recurrence rate(35.3%) is significantly higher than patients without metabolic syndrome group(16.4%)(P=0.029). Recurrence of 24 cases, 14 cases of paroxysmal AF, the recurrence rate(15.9%) was significantly lower than persistent AF recurrence rate(52.6%).3. Recurrence compared in different groups: 7 cases of patients combined with metabolic syndrome in paroxysmal AF(29.2%), recurrence rate is significantly higher than the other group(10.9%)(P=0.038); Persistent AF group recurrence rate had no significant difference between patients with metabolic syndrome or not(P=0.123).4. Cox multivariate regression model shows that the metabolic syndrome is an independent predictor of recurrence of atrial fibrillation ablation(HR=3.94, P=3.94); Left atrial diameter and persistent atrial fibrillation are independent predictors of recurrence, hypertension, hyperlipidemia and diabetes have effects on catheter ablation of atrial fibrillation recurrence, but there was no significant statistical difference(P>0.05). ConclutionsBy analyzing the clinical and follow-up datas of 107 patients who underwent atrial fibrillation catheter ablation, we got the following conclusions: 1. The atrial fibrillation recurrence rates between the different groups had significant difference, which was significantly correlated with whether got metabolic syndrome or not. 2. The proportion of patients with persistent atrial fibrillation combined metabolic syndrome is significantly higher than the paroxysmal atrial fibrillation group. 3. Metabolic syndrome had significant correlation with time on catheter ablation of atrial fibrillation recurrence rate, with time passed, recurrence rate of catheter ablation and recurrence rate in paroxysmal atrial fibrillation group become more and more significant between patients with or without metabolic syndrome, but persistent AF group has no obvious correlation with time. 4. Cox multivariate regression model shows that the metabolic syndrome is an independent predictor of recurrence of atrial fibrillation ablation, left atrial diameter and persistent atrial fibrillation are independent predictors of recurrence after catheter ablation. To hypertension, hyperlipidemia, diabetes, the risk of catheter ablation of atrial fibrillation recurrence ratio is high, but there was no significant statistical difference.Part 2.The role and possible mechanism of C-reactive protein,fibrinogen, and the left atrial diameter in the recurrence ofpatients with metabolic syndrome after catheter ablation ofatrial fibrillation ObjectiveBased on 107 cases of catheter ablation in patients with atrial fibrillation clinical examination results, explore the relationship among the left atrial diameter(LAD), C-reactive protein(CRP) and fibrinogen(Fib). To explore the reasons and possible mechanism of the metabolic syndrome on the recurrence of atrial fibrillation ablation. Methods1. Collected patients basic clinical datas and related follow-up datas, include:(1) CRP and Fib results;(2) transthoracic echocardiography. Analysis the differences of CRP, Fib and LAD in different groups.2. Analyzed with SPSS 13.0 statistics software. Measurement datas used mean +/-standard deviation, represented by two independent samples t-test. The count datas used the percentage(%), represented by chi-square test. With bilateral test P<0.05 for the difference is significant. Results1. The typies of AF, the proportion of metabolic syndrome LAD and LVEF comparison: the recurrence of persistent AF group(52.6%) is significantly higher than that of paroxysmal AF group(15.9%)(P<0.01). The proportion of metabolic syndrome in persistent AF(52.6%) is significantly higher than that of paroxysmal AF group(27.3%)(P=0.032). LAD in persistence AF(43.1±7.3) is significantly greater than that in paroxysmal AF(34.8±4.9)(P=0.0018). LVEF has no significant difference between the persistent AF and paroxysmal AF(P=0.117).2. Comparison between paroxysmal AF group and persistent AF group in LAD and LVEF: LAD in persistent AF group(42.1± 7.9) is significantly greater than that of paroxysmal AF group(36.8±7.8)(P = 0.003); LVEF is no significant difference between the two groups(P = 0.128).3. Comparison between metabolic syndrome group and non-metabolic syndrome group in CRP and Fib: CRP in metabolic syndrome group(5.43±2.45) is significantly higher than that in non-metabolic syndrome group(3.01±2.67)(P = 0.019). Fib in metabolic syndrome group(4.02±1.89) is significantly higher than that in non-metabolic syndrome group(3.04±1.91)(P = 0.034). ConclutionsLAD is an independent predict factor in recurrence of atrial fibrillation after catheter ablation. CRP and Fib content were obviously higher in metabolic syndrome group than that in non-metabolic syndrome group. It is the same as LAD in the two groups. CRP and Fib, as the representative of the inflammatory factors, can be through a variety of molecules, cytokines, growth factors and other way effects on the cardiovascular system, to make the myocardial ischemia, enhance inflammatory responses, aggravate the degree of myocardial fibrosis, decrease the myocardial and vascular elasticity, etc. The metabolic syndrome, by activating the body of the rennin-angiotensin-aldosterone system(RAAS), with CRP and fibrinogen, cause LAD increase, atrial electrical remodeling, anatomical reconstruction, thus have synergistic effect on catheter ablation of AF.