A Study Of The Circumferential Pulmonary Veins Scar Caused By Catheter Ablation And Its Relationship With Postoperative Early Recurrence In Atrial Fibrillation

Objective: This study aims to study the scarring imaging of the circumferential pulmonary veins by delayed gadolinium magnetic resonance after catheter ablation and its relationship with postoperative early recurrence in atrial fibrillation(AF).Methods: All datas were collected from the patients who had nonvalvular atrial fibrillation(NVAF) patients and planed to undergo radiofrequency ablation of Fujian Provincial Hospital between January 2012 and December 2013,including 19 males and 11 females. Thirty patients received electrocardiography and Holter, 23 patients were in diagnosis of paroxysmal AF, 7 patients were persistent AF. Everyone accepted the routine examinations, including laboratory tests(complete blood count, biochemistry is a full-service, coagulation,etc), Echocardiography(left atrial diameter), chest X-ray,transesophageal echocardiography(TEE), computed tomography Angiography(CTA),to exclude surgical contraindication. All patients were undergoing cardiac magnetic resonance and delayed gadolinium–cardiac magnetic resonance imaging(DE-c MRI) for the scars of the circumferential pulmonary veins in left atrial at postoperative 3 months,13 patients were received cardiac magnetic resonance scan at preoperative, but one were excluded due to the fail of respiratory-gated, another one refused DE-c MRI. Diagnose AF recurrence through medical history, physical examination, electrocardiography monitoring, regular electrocardiography and Holter. We compared the difference magnetic resonance methods by using Paired t test, and analyzed the relationship between the scarring ratio of circumferential pulmonary veins and postoperative early recurrence in atrial fibrillation by using Progressive Cox regression model and Rank sum test.Results: To prove the scarring ratio of circumferential pulmonary veins has changed after operation by cardiac magnetic resonance scan((6.77±1.69)% VS(43.62±14.33)%)。The scarring ratio in no recurrence patient are significantly more than the scarring ratio in recurrence by DE-c MRI((81.61±6.68)% VS(61.84±4.72)%), and the scarring ratio is only influencing factor for postoperative early recurrence of AF by using Progressive Cox regression(P<0.05), other clinical features areirrelevant with postoperative early recurrence of AF. Confirmed the negative correlation between the scarring ratio and postoperative early recurrence of AF by using Rank sum test(R=-0.664,P<0.05). The correlation between the other clinical features and postoperative early recurrence as follow, age((57.04±10.03)years,P=0.867),history of AF((2.41±2.68)years,P=0.440),19 patients as male(67.86%,P=0.342), 22 patients had paroxysmal AF(78.57%,P=0.070),BMI((24.02±2.37)kg/cm2,P=0.556),LAD((405.96±50.95)mm,P=0.641),7 patients had hypertension(25%,P=0.863), 2 patients had CHD(7.14%,P=0.342),2 patients had vasovagal reflex during operative(7.14%,P=0.104),4 patients had electrical cardioversion(14.29%,P=0.113). Diabetes were not found.Conclusion: 1. Radiofrequency ablation can damage the tissue of circumferential pulmonary veins and create stable scar,as the basis for maintaining sinus rhythm; 2.The relationship between the scarring ratio of the circumferential pulmonary veins after catheter ablation and postoperative early recurrence of AF is negatively; 3.Decreasing of the circumferential pulmonary veins scars is an independently associated factor with postoperative early recurrence of AF after radiofrequency catheter ablation.