Predictive Value Of Left Atrial Volume Index And NT-proBNP For Atrial Fibrillation Early Recurrence After Catheter Ablation

Objective :The aim of the study was to investigate the predictive valve of the left atrial volume index and NT-pro BNP in patients with atrial fibrillation(AF)recurrence after radiofrequency ablation.Methods:Totally one hundred and thirty-eight patients(79 male,59 female)with non valvular atrial fibrillation(NVAF)admitted from january 2017 to October 2017 in our hospital accepted radiofrequency catheter ablation(RFCA)were included in the present study.Paroxysmal AF was present in 107 patients(77.54%)and 31 patients(22.46%)were persistent AF.All patients were routine examination before surgery.All patients underwent circumferential pulmonary vein ablation(CPVA)guided by 3-dimentional electroanatomical mapping system.The endpoint of CPVA was pulmonary vein isolation(PVI).Linear ablations in the roof and mitral isthmus would be performed after PVI in patients with persistent AF.External cardioversion was needed if AF was still sustained.NT-pro BNP,LAVI were examined respectively before and 1,3 months after the ablatiaon.We evaluated the effcacy of atrial fibrilation recurrence after 1,3months of postoperative follow up.Results :(1)There were one hundred and thirty-eight patients with atrial fibrillation(AF)accepted radiofrequency catheter ablation(RFCA)included in the present study.All patients performed circumferential pulmonary vein isolation.Twenty patients(14.49 %)suffered from recurrent AF after 3 months of follow up.Recurrent paroxysmal AF was present in 11 patients and 9 patients were persistent AF.(2)Univariate analysis shows that type of AF(no-recurrent paroxysmal AF 96patients(81.35%),recurrent paroxysmal AF 11 patients(55.00%),P=0.009),left atrial dimension(LAD)(no-recurrent group 40.00±5.09 mm,recurrent group44.25±6.75 mm,P=0.005)and Left atrial volume index(LAVI)(no-recurrent group39.54±8.96ml/ ?,recurrent group 50.20±11.74ml/ ?,P<0.0001)was significant difference(P<0.01).Multivariate logistic regression revealed that type of AF(P=0.012,OR=0.28,95%CI=0.104-0.758),left atrial dimension(LAD)(P=0.03,OR=0.883,95%CI=0.814-0.959)and Left atrial volume index(LAVI)(P<0.001,OR=1.92,95%CI=0.881-0.963)were independent predictors of recurrence.(3)Left atrial volume index(LAVI)before the ablation(no-recurrent group 39.54±8.96ml/?,recurrent group50.20±11.74ml/?,P<0.0001)was significant difference between two groups(P<0.01),and NT-pro BNP before the abation(no-recurrent group 633.31±830.65pg/ml,recurrent group 651.00±473.94pg/ml,P=0.127)was no significant difference(P>0.05).NTpro BNP examined 1months after the ablation(no-recurrent group346.53±368.29 pg/ml,recurrent group 539.00±305.04pg/ml,P=0.024),NT-pro BNP examined 3 months after the ablation(no-recurrent group 234.63±170.85pg/ml,recurrent group 599.50±357.75pg/ml,P=0.010),LAVI examined 1months after the ablation(no-recurrent group37.34±7.67ml/?,recurrent group 46.05±10.14ml/?,P=0.015),LAVI examined3 months after the ablation(no-recurrent group36.79±7.44ml/?,recurrent group46.85±12.00ml/?,P=0.035)the no-recurrent group was smaller than that in recueernt group and was significant difference(P<0.05).(4)Taking NT-pro BNP percentage reduction after 1 month and preoperative LAVI to predict recurrence of atrial fibrillation,1 month after the NT-pro BNP percentage drop area under the ROC curve is 0.835,1 month after the NT-pro BNP percentage reduction?25.16%,predict the sensitivity of the recurrence of atrial fibrillation is 84.7%,specificity of 75.0%,Preoperative LAVI area under the ROC curve is 0.874,LAVI?50ml/? predicted recurrence of atrial fibrillation with the sensitivity of 78.9% and specificity of 80.7%Conclusion:1.NT-proBNP before the ablatiaon is not an independent predictors of AF recurrence in patients after radiofrequency catheter ablation.2.There was no significantly reduced NT-proBNP after the ablatiaon is an factor in predicting the recurrence of atrial fibrillation,1 month after the NT-pro BNP percentage reduction?25.16%,predict the sensitivity of the recurrence of atrial fibrillation is 84.7%,specificity of 75.0%3.LAVI is an independent predictor of recurrence of atrial fibrillation.We found that LAVI?50ml/? can be used as a high risk predictor index for the recurrence of atrial fibrillation radiofrequency ablation(Sensitivity 78.9%,specificity of 80.7%).