| Objective To investigate the characteristics and predictive value of the rate of change of decelerating capacity of rate(DC)in patients with paroxysmal Atrial Fibrillation(PAF)undergoing circulatory pulmonary vein isolation(CPVI).Methods From January 2015 to January 2017 in Department of Cardiology,the First Affiliated Hospital of Soochow University,133 patients were diagnosed with paroxysmal atrial fibrillation and suffered CPVC for the first time,as the PAF group,in addition,131 healthy controls were normal Group.24-hour Holter examination was employed to compare the age,gender,heart rate deceleration,accelaration capacity of heart rate(AC),heart rate variability(HRV;such as SDNN,RMSSD)and 24 h average heart rate(AHR)differences between the two groups.Patients with paroxysmal atrial fibrillation who underwent CPVI surgery were followed up for 12 months,and their Holter examinations were recorded preoperatively,3 days after surgery,3 months after surgery and 6 months after surgery,respectively.According to whether the surgery relapse after 3 months,patients were divided into recurrence group(36 cases)and no recurrence group(97cases).Then,DC,DC change,DC change rate,AC,AC change,AC change rate and HRV related index were analyzed in each period of recurrent group and no recurrent group to describe the sensitivity and specificity ROC curve,which could predict the recurrence rate of patients with paroxysmal AF after CPVI.Kaplan-Meier analysis was used to analyze the effect of DC Change Rate on Recurrence of Paroxysmal Atrial Fibrillation.RESULTS 1)Compared with control group,DC value,AC absolute value,SDNN and RMSSD in PAF group were significantly higher(P <0.05),while,24 h mean heart rate decreased than those in control group(P <0.05);2)Regardless of the control group or the PAF group,there was no significant difference between male and female indicators;There was no significant difference in DC values between the two groups(P>0.05).However,the AC absolute value was higher in male than in control males;Compared with the same sex,the average heart rate was slower than the control group,SDNN,RMSSD were higher than the control group.3)No matter whether the control group(r<-0.262,P<0.01)or PAF group(r<-0.548,P<0.01),the DC values were negatively correlated with age.;Compared with the controls,the PAF group's DC value increased(P<0.05)whose age <60 years old,and The DC value of patients aged ?60 years only have increased trend(P>0.05).4)Compared with no recurrence group,there was no significant difference in preoperative indicators of recurrence;On the 3rd postoperative day,SDNN and RMSSD increased significantly(P<0.05);After 3 months,DC,AC absolute,SDNN,RMSSD and other indicators were higher than those without recurrence(P<0.05);The DC and AC absolute values were still higher than those in the non-recurrent group at 6 months after operation.5)Compared with the non-recurrent group,the rate of change of DC before and after the 3rd day was significantly lower in the recurrent group.And its predicted the area under the ROC curve of postoperative recurrence of patients with paroxysmal atrial fibrillation was0.669.According to the Kaplan-Merier survival analysis,the recurrence rate was significantly lower in patients with atrial fibrillation whose DC change rate was> 0.30(log rank = 6.956,P <0.05).Conclusion The DC value was increased in patients with paroxysmal atrial fibrillation;Preoperative and postoperative 3-day DC rate of change has predictive value for postoperative recurrence in patients with atrial fibrillation after CPVI.When DC change rate ? 0.30,recurrence rate in patients with paroxysmal atrial fibrillation was significantly lower. |
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