Medium And Long Term Follow-up Analysis Of Cryoballoon And Radiofrequency Ablation For Atrial Fibrillation

Objective: To investigate the efficacy of Cryoballoon ablation(CBA)and radiofrequency catheter ablation(RFCA)in the treatment of patients with atrial fibrillation(AF)and their differences in myocardial injury.And analyze the risk factors for recurrence after the atrial fibrillation ablation.Method: A total of 124 patients with atrial fibrillation who had undergone circumferential pulmonary vein isolation(CPVI)in our hospital from March 2016 to May2017 were selected and divided into two groups according to different ablation procedures:CBA group(n=69),and RFCA group(n=55).Samples of cardiac troponin I(c Tn I)were collected before the operation,within 6-12 h after the operation and within 3-5 days after the operation.Patients were regularly followed by an outpatient or telephone follow-up after discharging from the hospital.After a blank period of 3 months,a ECG recording to atrial fibrillation,atrial flutter or atrial tachycardia,or a recording of atrial fibrillation,atrial flutter or atrial tachycardia lasting more than 30 s on a Holter examination was considered as a postoperative recurrence and was recorded as an endpoint event.Results: 1)Compare with the preoperative c Tn I level,the c Tn I value both had an increase in the CBA group and RFCA group within 6-12 h after the operation(P<0.001)and both had a decrease within 3-5 days after the operation(P<0.001).At the same time,compare with the RFCA group,the CBA group had a higher increase in the c Tn I level no matter within 6-12 h or 3-5 days after the operation(P<0.001),but there was no difference in preoperative c Tn I levels between the two groups.2)During the follow-up,25(37%)of the 67 patients in the CBA group recorded endpoint events after a blank period of 3 months after the operation,42(63%)patients had no recurrence;18(35%)of the 52 patients in the RFCA group recorded endpoint events after the blank period and 34(65%)patients did not have recurrence.There was no significant difference between the two groups(P=0.761).3)Severe complications such as atrial esophageal fistula,phrenic nerve injury,and severe pulmonary vein stenosis did not occur during the follow-up in both groups.4)There was adifference in the left atrial diameter(LAD)between the recurrence group and the non-recurrence group.The recurrence group had a larger LAD size than the non-recurrence group(66.43±11.80 vs 40.49±5.09,P=0.012).After multivariate logistic regression analysis,LAD was found to be an independent risk factor for recurrence after atrial fibrillation ablation(OR = 1.090,95% Cl: 1.008 ~ 1.178,P = 0.032).Conclusion: The efficacy and safety of cryoballoon ablation in the treatment of atrial fibrillation was not inferior to radiofrequency catheter ablation.The degree of myocardial injury is greater in the cryoballoon ablation than radiofrequency catheter ablation.The more increase of c Tn I after cryoballoon ablation indicated a better prognosis.LAD is an independent risk factor for predicting recurrence after AF ablation.