| Background: Atrial fibrillation(AF)is one of the most common tachyarrhythmias.The incidence of AF is increasing by aging process and its pathogenesis is complicated.AF may lead to many complications and has been a progressive social burden in recent years.For paroxysmal AF treatment,Radiofrequency catheter ablation(RFCA)is recommended as first-line therapy widely.RFCA can halt AF effectively and result in little complications to improve the quality of life of the patients.However,RFCA costs expensively and has the disadvantage of higher recurrence rate.Therefore,it is important to evaluate the effect of paroxysmal AF after RFCA for a reasonable choice of patients,increased chances of success and prevention of complications.The size of the left atrium is an independent risk factor for recurrence of AF after RFCA.The left atrial volume index(LAVI)corrected by body surface area is a reliable measure of the size of the left atrium with less error and higher accuracy.Some research shows that there is a good correlation between P wave duration and LAVI.LAVI(ml/m2)=8.0+0.2*maximum P wave duration(millisecond).In this study,we received LAVI based on the surface electrocardiogram of 181 patients with paroxysmal AF to explore the relationship with recurrence of paroxysmal AF after RFCAObjectives: The purpose of this study was to explore the relationship between LAVI based on the surface electrocardiogram and recurrence of paroxysmal AF after RFCA.Methods: Totally 181 patients(113 males,68 females)with paroxysmal AF who underwent RFCA in the department of cardiology of the first affiliated hospital of Soochow university from June 2015 to March 2017 were enrolled in this study.On the day of hospital admission,a 12-lead synchronized surface electrocardiogram was given for every patient.6-10 clear and stable cardiac cycles were recorded.The paper speed was 25 mm/s and the gain was 1m V/mm.Then we got the maximum P wave duration through measurement.At last,we received LAVI by the formula LAVI=8.0+0.2*maximum P wave duration.All cases were followed one year.All patients were divided into early recurrence group and early non-recurrence group according to the follow-up results within 3 months after RFCA.Patients with early recurrence were divided into late recurrence group and late non-recurrence group according to the follow-up results of 3-12 months after RFCA.All patients were divided into late recurrence group and late non-recurrence group according to the follow-up results within 3-12 months after RFCA.Results: Follow-up results showed that there were 51 patients with early recurrence.Average LAVI of this group was 34.04ml/m2 and 34 patients of them were converted to sinus rhythm spontaneously.There were 130 patients with early non-recurrence.Average LAVI of this group was 30.27ml/m2.LAVI was statistically different between early recurrence group and early non-recurrence group(34.04±3.69 vs.31.48±3.8ml/m2,P=0.013),but left atrial diameter was not statistically different(P=0.140).Logistic regression analysis showed that LAVI was an independent risk factor for early recurrence of paroxysmal AF after RFCA(P=0.016).The area under the receiver operating characteristics(ROC)curve for LAVI was 0.628 with a standard error of 0.045 and a 95% confidence interval of(0.539,0.717).Left atrial diameter(P=0.001),course of disease(P=0.048)and LAVI(36.18±1.73 vs.31.50±3.04ml/m2,P=0.001)were statistically different between late recurrence group in patients with early recurrence and late non-recurrence group in patients with early recurrence,Logistic regression analysis showed that course of disease(P=0.032)and LAVI(P=0.001)were independent risk factors for late recurrence in patients with early recurrence of paroxysmal AF after RFCA.The area under the ROC curve for LAVI was 0.922 with a standard error of 0.036 and a 95% confidence interval of(0.852,0.993).Left atrial diameter(P=0.001),course of disease(P=0.01),LAVI(34.41±2.32 vs.30.27±3.77ml/m2,P=0.001)were statistically different between late recurrence group and late non-recurrence group.Logistic regression analysis showed that preoperative heart rate(P=0.026),left atrial diameter(P=0.015),LAVI(P=0.002)were independent risk factors for late recurrence of paroxysmal AF after RFCA.The area under the ROC curve for LAVI was 0.821 with a standard error of 0.041 and a 95% confidence interval of(0.740,0.902).Conclusion: 1.The LAVI based on the surface electrocardiogram is more accurate and sensitive than the left atrium diameter to evaluate the size of the left atrium.2.LAVI is an independent risk factor of late recurrence in patients with early recurrence,late recurrence and early recurrence of paroxysmal AF after RFCA.3.LAVI has a strongest predictive value for late recurrence in patients with early recurrence of paroxysmal AF after RFCA.We believe that patients of early recurrence with LAVI>34.62 ml/m2 should be actively followed up for regular electrocardiographic monitoring such as electrocardiogram or 24-hour dynamic electrocardiogram. |
