Predictive Value Of 48h Ambulatory Electrocardiogram Monitoring On Late Recurrence Of Paroxysmal Nonvalvular Atrial Fibrillation After Catheter Ablation

Background: The latest guide has recommended catheter ablation for first-line treatment of atrial fibrillation,but there is still a high risk of recurrence.At present,many factors such as atrial fibrillation course and left atrial diameter(LAD),P wave,inflammatory factors,have been confirmed to be associated with recurrence after ablation.However,it is still rarely reported whether the monitoring of conventional ambulatory electrocardiograms has any significance for the recurrence.We aimed to study the related risk factors of late recurrence in paroxysmal nonvalvular atrial fibrillation(NVPAF)patients after catheter ablation,in particular,the value of 48 h ambulatory electrocardiogram examination.Methods: Two hundred and forty-four NVPAF patients who were hospitalized and received catheter ablation in Nanjing Medical University First Affiliated Hospital from January 2016 to January 2017 were enrolled.The patients were followed up for 16±4.5 months and divided into late recurrence group(n=45)and non-recurrence group(n=199).First part:Two groups of clinical baseline data were retrospectively analyzed.Multivariate logistic regression analysis was used to explore independent predictors of late recurrence after catheter ablation.Second part:A further study of 38 patients with recurrence within 3 months of 244 patients,The patients were also divided into late recurrence group(n=14)and advanced non-recurrent group(n=24).The baseline data were compared between the two groups.Multivariate Logistic regression analysis was used to explore independent predictors of late recurrence after catheter ablation for patients with recurrence within 3 months.Results: First part:Compared between the two groups,the course of atrial fibrillation in the late recurrence group was significantly greater than that in the late non-recurrence group(P<0.01).The left atrial diameter(LAD)was higher in the late recurrence group than in the late non-recurrent group(P=0.037).The recurrence within 48 hours after operation in the late recurrence group was higher than that in the late non-recurrence group(P<0.01).The recurrence within 3 months after operation was also higher than that in the late non-recurrence group(P=0.001).The results of logistic regression analysis showed that early recurrence within 48h(OR=5.601,95% CI:1.390-22.564,P=0.015<0.05)was an independent predictor for late recurrence after NVPAF catheter ablation.Second part:For patients with early recurrence,if LAD is increased,the risk of late recurrence will increase.Conclusion: 1.Early recurrence within 48 h can be used as a valid predictor of late recurrence after NVPAF catheter ablation.In patients with early recurrence,and electrocardiographic monitoring or dynamic electrocardiogram at 48 hours after operation can enhance the detection rate of late recurrence.2.When recurrence patients within 3 months with left atrium diameter abnormalities,the risk of late recurrence will increase,even if the light,moderate left atrial diameter increases,left atrial diameter index predicts late recurrence in patients with recurrence within 3 months still has clinical value.