| Objective: Inflammation is increasingly recognized to play a significant role in the genesis and perpetuation of atrial fibrillation(AF).Markers of inflammation such as C-reactive protein(CRP)are found to be predictive of increased risk for future development of AF.Inflammation has been linked to the genesis of early recurrent arrhythmia after AF ablation.In recent years,radiofrequency(RF)ablation gradually become an important means of treatment of AF,due to good treatment effect.But there is a recurrence,especially for persistent AF is more so.But the exact factor that is lead to relapse remains unclear.In recent years,the time course of inflammation,myocardial Injury,and prothrombotic response after RF ablation for AF be more and more attention.But the time course of inflammation,myocardial Injury,and prothrombotic response after RF ablation for persistent AF and paroxysmal AF and its relationship with the recurrence of AF have no unified conclusion.The purpose of this study is to observe the time course of inflammation,myocardial Injury,and prothrombotic markers after RF ablation for persistent AF and paroxysmal AF.To observe the difference between groups and its relation to AF recurrence,so that can provides the further clinical treatment basis for patients with different types of AF after RF ablation.Methods: One hundred and twenty-six consecutive AF patients undergoing RF ablation at the Second Hospital of Hebei Medical University between December 2015-March 2017 were recruited.Divided into persistent AF and paroxysmal AF group?High-sensitivity C-reactive protein(hs-CRP),total white cell count(WBC),neutrophil count(NE),creatine kinase(CK),creatine kinase-MB(CKMB),Troponin,Fibrinogen,and D-Dimerconcentrations(D-Dimer)were measured at baseline,at 1,2,3days,1,2,3weeks,and at 1,2month after ablation.AF recurrence was documented at 3day,4days-3months,3-12 months follow-up.Results: Inflammation,myocardial Injury,and prothrombotic response markers increased significantly with time after RF ablation for AF(P<0.001 for all markers).1 Time Course of Inflammation,Myocardial Injury,and Prothrombotic Markers1.1 hs-CRP: Within the group comparison,difference 1,2,3days,1,2,3weeks,and at1,2month after ablation was statistically significant(P<0.05).hs-CRP peaked at 3 day and was significantly elevated at days 2 to 3 after RF ablation for the persistent AF group.hs-CRP peaked at 2 days and was significantly elevated at 1 day to 1 week after RF ablation for the paroxysmal AF group.Comparison between groups,although,there was a trend of the hs-CRP after the operation elevated more significantly in the persistent AF group than that in the paroxysmal AF group,the differences were not statistically significant(P>0.05).1.2 Total WBC neutrophil count: Within the group comparison,difference 1,2,3,days,1,2,3weeks,and at 1,2 month after ablation was statistically significant(P<0.05).The WCC count peaked at 1 day and was significantly elevated at days 1 to 2 after RF ablation for the persistent AF group and paroxysmal AF group.There was no statistically significant between the persistent AF group and paroxysmal AF group(P>0.05).1.3 Neutrophil count: The neutrophil count peaked at 1 day and was significantly elevated at days 1 to 2 after RF ablation for the persistent AF group.The neutrophil count peaked at 1 day after RF ablation for the paroxysmal AF group.There was no statistically significant between the persistent AF group and paroxysmal AF group(P>0.05).1.4 CK: Within the group comparison,difference 1,2,3,days,and at 1,2weeks after ablation was statistically significant(P<0.05).The CK peaked at 2 day after RF ablation for the persistent AF group.The CK peaked at 1 day and wassignificantly elevated at days 1 to 2 after RF ablation for the paroxysmal AF group.Comparison between groups,although,there was a trend of the CK after the operation elevated more significantly in the persistent AF group than that in the paroxysmal AF group,the differences were not statistically significant(P>0.05).1.5 CKMB: Within the group comparison,difference 1,2,3,days,and at 1,2weeks after ablation was statistically significant(P<0.05).The CKMB peaked at 1 day after RF ablation for the persistent AF group and paroxysmal AF group.Comparison between groups,although,there was a trend of the CKMB after the operation elevated more significantly in the persistent AF group than that in the paroxysmal AF group,the differences were not statistically significant(P>0.05).1.6 Troponin:Within the group comparison,difference 1,2,3,days,and at 1,2weeks after ablation was statistically significant(P<0.05).The Troponin peaked at 1 day and was significantly elevated at days 1 to 2 after RF ablation for the persistent AF group and paroxysmal AF group.there was no statistically significant between the persistent AF group and paroxysmal AF group(P>0.05).1.7 Fibrinogen: Within the group comparison,difference 1,2,3,days,1,2,3weeks,and at1,2 month after ablation was statistically significant(P<0.05).Fibrinogen peaked at 3 day and was significantly elevated at days 2 day to 1week after RF ablation for the persistent AF group and paroxysmal AF group.There was statistically significant between the persistent AF group and paroxysmal AF group.Comparison between groups,although,there was a trend of the Fibrinogen after the operation elevated more significantly in the persistent AF group than that in the paroxysmal AF group,the differences were not statistically significant(P>0.05).1.8 D-Dimer: Within the group comparison,difference 1,2,3,days,1,2,3weeks,and at1,2 month after ablation was statistically significant(P<0.05).The D-Dimer peaked at 1 week after RF ablation for the persistent AF group.The D-Dimer peaked at 1 week and was significantly elevated at days 1 day to1 week after RF ablation for the paroxysmal AF group.Comparison between groups,although,there was a trend of the D-Dimer after the operation elevated more significantly in the persistent AF group than that in the paroxysmal AF group,the differences were not statistically significant(P>0.05).2 AF recurrence.The extent of the extent of inflammation and prothrombotic response markers elevation predicted very early AF recurrence within 3 days after procedure(P<0.05),but not at 4 days-3months or 3-12 months.(P>0.05).There was a significant trend toward higher AF recurrence in patients with the persistent AF compared with the paroxysmal AF(P<0.01).There was a statistically significant between the persistent AF group and paroxysmal AF group(P>0.05)in 3 days and 3days to months for the AF recurrence,while in3-12 months the differences were not statistically significant(P > 0.05).Conclusions:1 The patients undergoing RF ablation for the persistent AF and paroxysmal AF exhibit an inflammatory response within 3 days.But the differences were not statistically significant between groups.2 The prothrombotic markers are elevated at 1 week after ablation with patients undergoing radiofrequency ablation for the persistent AF and paroxysmal AF.3 The extent of inflammatory response predicts very early AF recurrence but not early and late recurrence.The AF very early and early recurrence rate is relatively high for the persistent AF group than the paroxysmal AF after RF ablation. |
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