Analysis Of Factors Related To Late Recurrence Of Atrial Fibrillation After Radiofrequency Ablation

Background:Atrial fibrillation(AF)is a common arrhythmia and is a severe disturbance of atrial electrical activity.In addition to atrial fibrillation caused by heart palpitations,fatigue and other discomfort,but also induced heart failure,cardiomyopathy,myocardial ischemia may be.The most serious harm is caused by thromboembolic diseases,such as cerebrovascular embolism,which may cause disability,seriously affecting the quality of life of patients,and even death.Therefore,the treatment of atrial fibrillation without delay,and a long way to go.At present,the treatment of atrial fibrillation is the first choice of catheterized radiofrequency catheter ablation,but some patients still have recurrence after operation.There have been many reports on the relapse factors after atrial fibrillation radiofrequency ablation.In clinical work,such patients can also be found to be successful in 1 year of ablation but recur after 1 year.The 2012 HRS / EHRA/ ECAS guidelines for atrial fibrillation define this recurrence as late stage of AF Recurrence.However,there are few literatures about the risk factors for the late recurrence of atrial fibrillation,so this study is to explore the related factors of late recurrence of atrial fibrillation.Objective: To retrospectively analyze the related predictors of late recurrence after atrial fibrillation after catheter ablation.Methods: From March 2011 to May 2016,227 patients with atrial fibrillation by catheter radiofrequency ablation were selected for the first time in Department of Cardiology,the First Affiliated Hospital of China Medical University to collect and sort out the relevant clinical data.There were 144 males(63.44%),83 females(36.56%),average age 58.00 ±10.13 years,172 cases of paroxysmal atrial fibrillation(75.77%)and 55 cases of persistent atrial fibrillation(24.23%).All patients must be confirmed before surgery at least one ECG or 24-hour Holter monitoring of atrial fibrillation,improve the relevant preoperative examination,and the excision of the left atrial appendage and left atrial thrombus by transesophageal echocardiography.If the ultrasound confirmed the existence of thrombosis in patients,the oral anticoagulant to the disappearance of thrombosis after elective surgery.All patients recovered sinus rhythm after surgery.Atthe end of November 2017,all patients were included in the study for more than 1 year after surgery.The follow-up time was divided into two groups according to whether there was atrial tachyarrhythmia(atrial tachycardia,atrial flutter and atrial fibrillation)one year after operation.Statistics of two groups of clinical data,univariate analysis,using Logistics multivariate analysis,the independent risk factors for late recurrence of atrial fibrillation.Results: 1.According to statistics,83 cases(36.56%)of late recurrence of atrial fibrillation occurred.2.The basic data and clinical data of two groups were analyzed by single factor risk factors,the results showed that there was no significant difference between the two groups in age,early recurrence,hypertension,type of atrial fibrillation,gender,number of lymphocytes(LY #),distribution width of red blood cells(RDW),BNP,LAD,CHADS2 score,CHA2DS2-VASc score,HAS-BLED score,DR-FLASH score and APPLE score(p <0.05).3.The variables with p value between 0.05 and 0.10were: atrial fibrillation course,neutrophil lymphocyte ratio(NLR)and glomerular filtration rate(eGFR).4.The results of logistic regression analysis showed that age(OR =1.05,95% CI: 1.014-1.088,p = 0.006),early recurrence(OR = 3.528,95% CI:1.927-6.460,p <0.001)DR-FLASH score> 3 points(OR = 3.209,95% CI: 1.265 ~ 8.143,p = 0.014)was an independent risk factor for AF recurrence.5.Compared with CHADS2 score,CHA2DS2-VASc score,HAS-BLED score and APPLE score,the area under the ROC curve of DR-FLASH score was the largest(AUC = 0.695,95% CI: 0.623-0.767,p<0.001).6.DR-FLASH score in the ?3 points,> 3 points,the difference between the two groups was statistically significant(p <0.001).Conclusion:1.Compared with patients without advanced recurrence,late recurrence and age,female,persistent atrial fibrillation,early recurrence,hypertension,lymphocyte count(LY #),distribution width of red blood cells(RDW),B-type natriuretic peptide BNP,LAD,CHADS2 score,CHA2DS2-VASc score,HAS-BLED score,DR-FLASH score and APPLE score.2.DR-FLASH score is better than CHADS2 score,CHA2DS2-VASc score,HAS-BLED score and APPLE score in predicting the late recurrence of atrial fibrillation.3.Age,early recurrence,DR-FLASH score> 3 points were independent risk factors for late recurrence of atrial fibrillation.