To Investigate The Changes Of Inflammatory Factors And Their Relationship With Postoperative Recurrence After Different Ablation Methods

Objectives To investigate the safety and efficacy of cryoablation ablation(CBA)and catheter radiofrequency ablation(RF)in the treatment of atrial fibrillation(paroxysmal atrial fibrillation).Research the transformation of inflammatory factors and myocardial injury markers by the above two different procedures.Exploring the relationship between the level of inflammatory factors?myocardial injury markers?other risk factors and the recurrence of paroxysmal atrial fibrillation(Pa AF)after cryoablation ablation(CBA)or catheter radiofrequency ablation(RF).Methods Between October 2015 and June 2016,111 patients with non-valvular paroxysmal atrial fibrillation(including the combined paroxysmal atrial flutter)referred to our center were studied.All patients abided by their volition to choose different operation.62 patients were assigned to undergo transseptal PVI using an open irrigated-tip radiofrequency catheter(RF group)and 49 patients using a cryoballoon catheter(CB group).All patients collected basic information,including age,gender,past medical history,complications(hypertension,diabetes and hyperlipidaemia,etc),medication and so on.Blood samples were obtained from the patients at pre-operation and 24 hours after operation.The levels of creatine kinase(CK),creatine kinase isoenzyme MB(CK-MB),troponin T(Tn T),glutamic oxalacetic transaminase(GOT),hypersensitive C-reactive protein(hs-CRP),White blood cell(WBC),Neutrophil-to-Lymphocyte Ratio(NLR),monocyte(M)and red blood cell distribution width(RDW)were measured by the fully automatic blood cell and biochemical analyzer in the Tianjin chest hospital laboratory.Interleukin-6(IL-6)was measured by Enzyma-linked Immunosorbent Assay(ELISA).To analyze the differences between the two groups before and after operation and whether there were differences between the two groups.The independent samples T-test and paired sample T-test were used to analyze the changes of these indexes before and after operation of the two groups.Logistic regression analysis was used to analyze the risk factors of two types recurrence(including early recurrence and late recurrence)and toexplore the relationship between the above-mentioned inflammatory factors.Record all selected cases into Excel software to establish a follow-up database.Follow-up visits were followed by regular follow-up and events follow-up.The patients were followed up at 1 week,1 month,3 months,6 months,and 9 months postoperatively.The follow-up included symptom description,routine 12-lead ECG,24-hour ambulatory electrocardiogram.Patients whom with symptoms at any time were asked to follow the ECG and other tests.Atrial fibrillation ablation was successfully defined as none conventional electrocardiogram or 24-hour ambulatory electrocardiogram recording more than 30 seconds of atrial fibrillation,atrial flutter or atrial tachycardia at 3 months after the ablation.Results1?The basic clinical data,intraoperative and prognosis of patients Of the 111 patients(63% male),49 patients were enrolled in the frozen balloon ablation group(CB group)and 62 patients were enrolled in the radiofrequency catheter ablation group(RF group).There was no significant difference in sex,age,duration time and left atrial diameter between the two groups(P> 0.05).Four patients in the CB group were treated with catheter ablation,5 patients of atrial flutter with cavotricuspid isthmus(CTI)ablation.The acute ablation rate of RF group was 100%,16 patients of atrial flutter with cavotricuspid isthmus(CTI)ablation.The duration of operation in CB group was shorter than that in RF group,the difference was statistically significant(P<0.05).There was no complication in the two groups,including pericardial tamponade,atrial esophageal fistula,pulmonary vein stenosis and thromboembolism,except for one case of phrenic nerve palsy in the CB group.After(10.5 ± 2.8)months follow-up,the early recurrence rate was 32.31% and the late recurrence rate was 27.27% in the RF group.The early recurrence rate was33.33% and the late recurrence rate was 24.14% in the CB group.One patient in the CB group underwent radiofrequency ablation of the secondary catheter after 6 months,and right superior pulmonary vein(RSPV)and right inferior pulmonary vein(RIPV)were recovered.After 3 months follow-up,no recurrence occurred.Three patients in the RF group underwent radiofrequency ablation after 6 months,and the RSPV recovered was found in 2 patients,1 patient with RSPV?left superior pulmonary vein(LSPV)and left inferior pulmonary vein(LIPV)recovered,after(5.6±2.3)months of follow-up,no recurrence occurred.2 ? The baseline levels and postoperative levels of inflammatory factors and myocardial injury markers in the CB group and RF group There were no significant differences in hs CRP,WBC,NLR,M,CK,CK-MB,Tn T,GOT and CV% between the two groups at baseline(P> 0.05).The levels of hs CRP,WBC,NLR,M,CK,CK-MB,Tn T and GOT were increased in both groups after operation.RDW and IL-6 were decreased in both groups after operation(P<0.05).The decline of Tn T,CK,CK-MB and GOT in the CB group were significantly higher than those in the RF group(P <0.05).3?The relationship between the inflammatory factors?myocardial injury markers and the recurrence of Pa AF of CB group and RF group.In the univariate analysis,we found that except the left atrial diameter(LAD)and sex(P <0.05)were independent risk factors for early recurrence in the RF group,the baseline level of IL-6,the postoperative IL-6 values,the postoperative WBC value and the postoperative M value were independent risk factors for early recurrence(P<0.05).While RDW was an independent risk factor for late recurrence,with statistical difference(P <0.05);In the logistic regression analysis,we found that the baseline level of IL-6 and the postoperative IL-6 values were independent risk factors for early recurrence(P <0.05),and by analyzing the higher incidence of IL-6 at the baseline level and the higher postoperative.Eearly recurrence of atrial fibrillation(ERAF)was an independent risk factor for late recurrence of atrial fibrillation(LRAF)(P <0.05)in the CB group.No correlation was found between other related inflammatory factors,myocardial injury markers and other risk factors in CB group.Conclusions1 ? Cryoablation,like radiofrequency catheter ablation,has a high safety and efficacy.2?The rate of myocardial enzyme elevation after cryoablation was higher than that of catheter ablation.3 ? There was a correlation between the inflammatory factors and the early recurrence of atrial fibrillation after radiofrequency catheter ablation,and no correlation with early recurrence after cryoablation.4 ? RDW was associated with late recurrence of atrial fibrillation after radiofrequency catheter ablation,and found no correlation with late recurrence after cryoablation.5?Early recovery of atrial fibrillation(ERAF)in cryoablation is an independent risk factor for late recurrence(LRAF).