| Objective: Atrial fibrillation(AF)is one of the most common arrhythmia in clinical practice,It has a serious impact on the quality of life.The most serious risk of AF is thromboembolism.However,current treatments for AF are inadequate.Traditional antiarrhythmic drug therapy will be accompanied by arrhythmia.Catheter ablation has become an effective treatment for AF.There are two main ways:cryoballoon ablation(CB-A)and radiofrequency(RF)ablation.In terms of safety,CB-A has an advantage over RF ablation.Some research suggested there were some changes in blood coagulation indexes and inflammation indexes after surgrey.However,there are few studies on the changes of blood coagulation indexes,the change of inflammatory markers and their relationship with the recurrence of AF.This study attempts to explore the changes of coagulation indexes and inflammatory indexes after paroxysmal atrial fibrillation(PAF)ablation,and their relationship with early and late recurrence,so as to provide some theoretical basis for the clinical treatment with postoperative patient.Method: The subjects of the study were the hospitalized patients with PAF and fitting line of RF ablation or CB-A at the Second Hospital of Hebei Medical University between March 2015-February 2017,a total of 142 cases.3cases had been lost to follow-up.1 case was excluded.Finally,a total of 138 cases were enrolled.They were randomly divided into two groups: CB-A group and RF group.CB-A group: a total of 68 cases,including 35 males and33 females.The operation style was frozen balloon atrial isolation.RF ablation group: a total of 70 cases,including 40 males and 30 females.Fitting line of RF ablation surgery was used.All patients before treatment need history taking,physical examination,laboratory tests,electrocardiogram and holter,transesophageal echocardiography and other preoperative examination,and signed a follow-up informed consent.Ablation surgery was performed by the same surgeon.All patients were treated with conventional anticoagulant therapy for 3 months.Coagulation indexes and inflammation indexes were measured before and after AF ablation at 1 day,2 days,3 days,1 week,2 weeks,3 weeks,4 weeks,2 months,3 months.The extent of the blood parameter was defined as the maximum value minus the baseline value before operation.Patients were asked to determine whether they had AF recurrence at 1 day,2days,3 days,1 week,2 weeks,3 weeks,4 weeks,2 months,3 months,6 months,9months,12 months by asking the patient's medical history,physical examination,or 12 lead electrocardiogram or Holter examination.Whenever they had symptoms of palpitation,DO ECG.The average follow-up time of the two groups was:7.95±3.78 months.The standard of recurrence of AF is the rapid atrial arrhythmia with a duration of more than 30 s.Super early recurrence was defined as recurrence within 3 days after surgery of AF.Early recurrence was defined as recurrence at 3 days to 3 months after ablation.Late recurrence was defined as at least 3 months after surgery.The overall number of recurrence was defined as the sum of the number of super early,early and late recurrence.Data were processed with SPSS 16.0 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.Two sample rates were compared using chi square test,P<0.05 was considered statistically significant.Univariate and multivariate logistic regression analysis was used to analyze the risk factors of AF recurrence,The correlation analysis of the extent of blood indexes were analyzed by Spearman rank correlation analysis.Results: All cases were successfully completed catheter ablation of AF,no postoperative pulmonary vein stenosis,thromboembolic events,pericardial tamponade,left atrial fistula and other complications.1 The general situation in two groups The total number of CB-A group of patients was 68: males 35 and females 33;the RF group of patients was 70: males 40 and females 30.The age,gender,smoking,drinking,hypertension,diabetes,myocardial infarction,heart failure,peripheral vascular disease,cerebrovascular disease,family history between the two groups had no statistical difference(P>0.05).2 Changes of coagulation indexes after PAF ablation Fib:RF group:There was a significant difference within the group(P<0.05).The index increased after 1 day,and then reached maximum value at 3 days(P<0.05),and then gradually reduced.The index at 1 week was still higher than that before operation(P<0.05).There was no significant difference between 2 weeks and preoperative(P > 0.05).CB-A group:There was a significant difference within the group(P<0.05).The index increased after 2 days,and then reached most maximum value at 1 week(P<0.05),and then gradually reduced.The index at 3 weeks after CB-A surgery was no significant difference compared with preoperative(P > 0.05).There was no statistical significance between the two groups(P>0.05).D-Dimer:RF group:There was a significant difference within the group(P<0.05).The index increased firstly,and then reached most maximum value at 1 week(P<0.05).and then gradually reduced.The index at 2 weeks was no significant difference compared with preoperative(P>0.05).CB-A group:There was a significant difference within the group(P<0.05).The index increased firstly,and reached maximum value at 1 day(P<0.05),and gradually reduced after 1 day.The index at 2 days after CB-A surgery was no significant difference compared with preoperative(P>0.05),and then gradually increased again,peaked at 1 week and no significant difference compared with 1 day(P>0.05),and gradually reduced again.The index at 2 weeks after CB-A surgery was no significant difference compared with preoperative(P>0.05).There was no statistical significance among the two groups(P>0.05).3 Changes of inflammatory indexes after PAF ablation Hs-CRP:RF group:There was a significant difference within the group(P<0.05).The index was increasing after operation firstly,2 days was the most maximum value(P<0.05),and gradually reduced,the index at 2 weeks was no significant difference compared with preoperative(P > 0.05).CB-A group:There was a significant difference within the group(P<0.05).The index was increasing after operation firstly,the index at 3 days was the most maximum value(P<0.05),and gradually reduced.The index at 2 weeks after CB-A surgery was no significant difference compared with preoperative(P>0.05).Comparison between groups:there was statistical significance between them(P<0.05).The range of CB-A group was higher than that of RF group.WBC:RF group:There was a significant difference within the group(P<0.05).The index was increasing after operation firstly,the index at 1day was the most(P<0.05),and gradually reduced,the index at 3 days was no significant difference compared with preoperative(P > 0.05).CB-A group:There was a significant difference within the group(P<0.05).The index was increasing after operation firstly,the index at 1 day was the most maximum value(P<0.05),and gradually reduced.The index at 3 weeks after CB-A surgery was no significant difference compared with preoperative(P >0.05).There was no statistical significance between the two groups(P>0.05).NE:RFgroup:There was a significant difference within the group(P<0.05).The index was increasing after operation firstly,the index at 1 day was the most(P<0.05),and gradually reduced,the index at 2 days was no significant difference compared with preoperative(P > 0.05).CB-A group:There was a significant difference within the group(P<0.05).The index was increasing after operation firstly,the index at 1 day was the most maximum value(P<0.05),and gradually reduced.The index at 3 days after CB-A surgery was no significant difference compared with preoperative(P > 0.05).There was no statistical significance between the two groups(P>0.05).NE%:RF group:There was a significant difference within the group(P<0.05).The index was increasing after operation firstly,the index at 1day was the most(P<0.05).and gradually reduced,the index at 2 days was no significant difference compared with preoperative(P > 0.05).CB-A group:There was a significant difference within the group(P<0.05).The index was increasing after operation firstly,the index at 1 day was the most maximum value(P<0.05),and gradually reduced.The index at 3 days after CB-A surgery was no significant difference compared with preoperative(P>0.05).There was no statistical significance between the two groups(P>0.05).LY:RF group:There was a significant difference within the group(P<0.05).The index delined after operation firstly,the index at 1 day was the minimum(P<0.05),and gradually increased,the index at 2 days was no significant difference compared with preoperative(P > 0.05).CB-A group:There was a significant difference within the group(P<0.05).The index delined after operation firstly,the index at 1 day was the minimum(P<0.05),and gradually increased,the index at 1 week was no significant difference compared with preoperative(P > 0.05).There was no statistical significance between the two groups(P>0.05).LY%:RF group:There was a significant difference within the group(P<0.05).The index delined after operation firstly,the index at 1 day was the minimum(P<0.05),and gradually increased,the index at 3 weeks was no significant difference compared with preoperative(P > 0.05).CB-A group:There was a significant difference within the group(P<0.05).The index delined after operation firstly,the index at 1 day was the minimum(P<0.05),and gradually increased,the index at 3 days was no significant difference compared with preoperative(P > 0.05).There was no statistical significance between the two groups(P>0.05).NE/LY:RF group:There was a significant difference within the group(P<0.05).The index was increasing after operation firstly,the index at 1day was the most(P<0.05).and gradually reduced,the index at 2 days was no significant difference compared with preoperative(P > 0.05).CB-A group:There was a significant difference within the group(P<0.05).The index was increasing after operation firstly,the index at 1 day was the most maximum value(P<0.05),and gradually reduced.The index at 3 days after CB-A surgery was no significant difference compared with preoperative(P>0.05).There was statistical significance between the two groups(P<0.05).The range of CB-A group was higher than that of RF group.4 Analysis of the relationship between coagulation indexes,inflammatory indexes,clinical data with the overall recurrence of AF:Univariate logistic regression analysis showed that the operation mode(OR,0.226;CI[0.085-0.603];P=0.003)was associated with the overall recurrence.The RF ablation group was more likely to recurre than the CB-A group.The fib value after 2 days(OR,2.428;CI [1.08-5.46];P=0.032),and the LY value after 1 day(OR,3.119;CI [1.056-9.21];P=0.039)were positively correlated with the overall recurrence of AF.The operation mode,the fib value after 2 days,the LY value after 1 day,were included in the multivariate logistic regression analysis,which suggested that the operation mode(OR,0.127;CI[0.035–0.465];P=0.002)was associated with the overall recurrence.The RF ablation group was more likely to recurre than the CB-A group.Analysis of the relationship between coagulation indexes,inflammatory indexes,clinical data with the early recurrence of AF:LAD(OR,1.117;CI[0.997–1.251];P=0.055),hypertension(OR,2.68;CI [0.878–8.178];P=0.083)were positively correlated with the early recurrence of AF.The operation mode(OR,0.302;CI [0.092–0.989];P=0.048)was associated with the early recurrence.The RF ablation group was more likely to recurre AF than the CB-A group.The LY value after 1 day(OR,4.017;CI [1.041–15.493];P=0.043)was positively correlated with the overall recurrence of AF.The operation mode,the LY value after 1 day,LAD,hypertension were included in the multivariate logistic regression analysis,which suggested that the operation mode(OR,0.165;CI [0.034–0.804];P=0.026)was associated with the early recurrence.The RF ablation group was more likely to recurre AF than the CB-A group.Analysis of the relationship between coagulation indexes,inflammatory indexes,clinical data with the late recurrence of AF: The operation mode(OR,0.223;CI [0.06–0.83];P=0.025)was associated with the late recurrence.The coagulation indexes,inflammatory indexes,clinical data did not show some relevence with the super early recurrence.5 Analysis of the relationship between the change of coagulation indexes(fib,D-Dimer)and the change of inflammatory indexes(hs-CRP ?WBC?NE?NE/LY?NE%?LY?LY%)after PAF ablation:The change of fib was positively correlated with the change of WBC(rs=0.283,P=0.002),the change of NE(rs=0.276,P=0.003),the change of hs-CRP(rs=0.255,P=0.006).There was no significant correlation between the D-Dimer and the inflammatory indexes.Conclusion:1 The fib and the D-Dimer were increased after PAF catheter ablation for a period of time.The fib at 1 day to 2-3 weeks after operation was higher than that before operation.The D-Dimer at 1 day to 2 weeks after operation was higher than that before operation.They all suggested that hypercoagulable state exist for a period of time after PAF catheter ablation.2 RF group:The fib began to increase at 1 day after the operation,peaked at 3 days,and returned to normal at 2 weeks.The D-Dimer began to increase after the operation,peaked at 1 week,and returned to normal at 2 weeks.CB-A group:The fib began to increase at 2 days after the operation,and peaked at 1week,and returned to normal at 3 weeks.The D-Dimer began to increase after the operation,and peaked at 1 week,and returned to normal at 2 weeks.3 The inflammatory indexes increased during the 2 weeks after PAF catheter ablation.The inflammatory response in RF group was higher than that in CB-A group.4 The change of fib was correlated with the change of some inflammation indexes.5 After PAF catheter ablation,the LY value after 1 day and the fib value after 2 days were positively correlated with the overall recurrence of AF.The LY value after 1 day was positively correlated with the early recurrence of AF. |
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