Predictive Value Of Serum Globulin Levels In The Recurrence Of Atrial Fibrillation After Radiofrequency Ablation

OBJECTIVE: To investigate the predictive value of serum globulin levels in the recurrence of atrial fibrillation(AF)after radiofrequency ablation.Methods: Screening of patients undergoing transcatheter radiofrequency ablation in the Second Affiliated Hospital of Chongqing Medical University from May 2011 to May 2015 to exclude severe organic heart disease,heart failure(EF<50%)and related factors affecting globulin levels,151 patients with atrial fibrillation who received catheter radiofrequency ablation for the first time were screened out.All of these patients underwent radiofrequency ablation of atrial fibrillation with three-dimensional electroanatomic mapping(CARTO 3,Biosense-Webster,USA)system.Among them,patients with paroxysmal atrial fibrillation were received pulmonary vein isolation(PVI)only.If other arrhythmias such as atrial flutter were induced during the procedure,corresponding mapping and ablation were performed.For patients with persistent atrial fibrillation,PVI was performed first,if atrial fibrillation resorted to sinus rhythm during or after PVI,no additional ablation was performed,and if the rhythm converted to atrial flutter or atrial tachycardia,corresponding mapping and ablation are performed.Left atrial Roof line,mitral isthmus line and tricuspid isthmus line ablation were performed in some patients depend on the operator's choice.If the atrial fibrillation continued afterablation,synchronous cardioversion was performed.All patients were treated with warfarin or new oral anticoagulant for at least 2 months after the procedure.If patients have no atrial arrhythmias during hospitalization,the antiarrhythmic drugs were discontinued;otherwise patients routinely received antiarrhythmic drugs for 1-3 months.Follow-up visits were performed at 1,3,6 months and 12 months post operation.Standard12-lead electrocardiogram and 24-hour electrocardiogram examination were performed.Patients with palpitations were recommended to preform electrocardiogram examination at any time.Success was defined as freedom from documented AF/atrial tachycardia lasting ?30 s after the 3month blanking period according to current guidelines.Peripheral venous blood samples were obtained before ablation to measure serum globulin levels before surgery.The recurrence of atrial fibrillation after radiofrequency ablation was followed up.Globulin levels were compared between recurrent and non-recurrent groups.RESULTS: Of the 15 l patients with AF,including 120 patients with paroxysmal AF and 31 patients with persistent AF.After 12 months of follow-up,atrial fibrillation recurred in 52 patients(34.4%).There were no significant differences in the baseline characteristics including gender,age,LDL,total cholesterol,triglycerides,smoking history,diabetes history,history of hypertension,history of coronary heart disease,etc between the recurrence group and the non-recurrent group.Compared with those who did not recurrence,patients in the recurrence group had lower average globulin levels.Multiplex COX regression analysis showed low baseline serum globulin levels(< 28.7 g/L)(AUC: 0.705,95% CI: 0.625–0.786),non-paroxysmal atrial fibrillation(HR: 0.692,95% Cl: 0.339-1.410,P:0.031),larger left atria(HR: 2.687,95% Cl: 1.450-4.979,P: <0.002)arepredictors of AF recurrence after radiofrequency ablation.According to ROC curve analysis,the best cut-off value of globulin was 28.7g/L,and the sensitivity to predict recurrence of atrial fibrillation was 61% and the specificity was 77%.CONCLUSIONS: Low baseline serum globulin level(<28.7 g/L)(AUC: 0.705,95% CI: 0.625–0.786)was the predictors of AF recurrence after radiofrequency ablation,non-paroxysmal AF(HR: 0.692,95)%Cl:0.339-1.410,P: 0.031),larger left atrial diameter(HR: 2.687,95% Cl:1.450-4.979,P: <0.002)were associated with AF recurrence after radiofrequency ablation.This suggests that low baseline serum globulin levels may be a predictor of recurrence of AF after radiofrequency catheter ablation.