Risk Factors Of Recurrent Atrial Fibrillation After Cryoballoon Ablation In The Elderly Patients With Chronic Comorbidities And Dynamic Changes In Their Depression And Quality Of Life

[Objective]This study aims to collect and analyze clinical data of the elderly atrial fibrillation?AF?patients with chronic comorbidities after cryoballoon ablation,investigate the relapse rate of AF,identify risk factors of recurrent AF,monitor the dynamic changes in the patients'quality of life and depression,and thus,conduct targeted care and help with the patients'recovery.[Method]This study recruited a total of 159 AF patients that underwent cryoballoon ablation between October 1,2016 and January 30,2018 at Shanghai Ruijin Hospital.All patients experienced paroxysmal AF and did not respond to or tolerate at least two antiarrhythmic drugs.The patient demographic information and disease-related risk factors were collected and analyzed.The atrial fibrillation effect on quality of life?AFEQT?was used to assess the patients'quality of life,the Zung self-rating depression scale?SDS?to assess the patients'depression,and CHA₂DS₂-VASc score to assess the patients'stroke risk.The patients'chief complaints,ECG and 24-hour Holter monitoring were investigated three months after the cryoballoon ablation.Recurrent AF is confirmed upon repeated palpitations,coupled with atrial fibrillation,atrial flutter or atrial tachycardia detected by ECG monitoring or above episodes lasting at least 30 seconds detected by Holter monitoring.The patients were categorized into recurrence group and non-recurrence group according to their AF relapse after cryoballoon ablation.The risk ratios in the two groups were compared using the single factor analysis.The Logistic regression analysis was used to identify independent risk factors of recurrent AF after cryoballoon ablation.The generalized linear mixed model was used to explore factors affecting the changes in patient's quality of life and depression.[Results]The follow-up visit was successfully conducted on 152 of the 159 patients.The completion rate was 95.6%.Among the 152 patients,41?27.0%?developed recurrent AF,versus111?73%?without recurrent AF.Their average age was 61.87±8.86 years.There were 99 males?65.1%?and 53 females?34.9%?,and 106?69.1%?experienced paroxysmal AF and 46?30.9%?experienced persistent AF.After cryoballoon ablation,the two groups showed statistical significances in BMI,etiological factors of AF,use of antiarrhythmic drugs,comorbidities,CHA₂DS₂-VASc score,resting heart rate,and left atrial diameter?LAD?.However,there were no statistical significances in age,gender,cigarette smoking,alcohol drinking,education background,household income per capita,fasting blood sugar and blood fat.Among patients with total AF,recurrent AF increases with the CHA2DS2-VASc score.Among patients with persistent AF,the highest recurrence occurs in those with?3 of CHA2DS2-VASc score,and the second highest recurrence occurs in those with 0 of CHA2DS2-VASc score.There was statistical significance in recurrence rate among the above three groups.Among total AF and paroxysmal AF patients,those with at least two comorbidities have significantly higher recurrence rate.The Logistic regression analyses have shown that independent risk factors of recurrent AF include BMI[OR1.147,95%CI1.009-1.174],hypertension[OR1.317,95%CI 1.076-2.809],irregular use of antiarrhythmic drugs[OR1.581,95%CI 1.351-2.125],?2 comorbidities?compared with 0-1 comorbidity?[OR2.466,95%CI1.375-4.452],and CHA₂DS₂-VASc score?3[OR2.088,95%CI 1.142-5.557].The resting heart rate[OR0.910,95%CI 0.821-0.986]has shown to be a protective factor for recurrent AF.Independent risk factors of recurrent AF in patients with paroxysmal AF include hypertension[OR1.743,95%CI1.275-3.767],?2 comorbidities?compared with 0-1 comorbidity?[OR2.938,95%CI 1.347-5.097],and CHA₂DS₂-VASc score?2[OR3.055,95%CI 1.361-5.873].The LAD[OR 0.900,95%CI 0.725-0.987]has shown to be a protective factor for recurrent AF.Independent risk factors of recurrent AF in patients with persistent AF include blood sugar[OR1.136,95%CI 1.017-2.662],?2 comorbidities?compared with 0-1 comorbidity?[OR4.187,95%CI 2.017-6.638],and CHA2DS2-VASc score 1[OR3.136,95%CI 2.620-4.961],and CHA₂DS₂-VASc score?2[OR4.121,95%CI 2.139-8.205].The generalized linear mixed model results have shown that only CHA2DS2-VASc score can predict the quality of life,and a higher CHA2DS2-VASc score indicates a better quality of life within three months.The results have also shown that only time has impact on SDS and the patients'depression tendency increases with time.[Conclusion]Despite its efficacy,some patients may experience recurrent AF after cryoballoon ablation.Weight loss,drug management and control of chronic comorbidities are helpful to reduce AF relapses after cryoballoon ablation.In the meantime,it's necessary to monitor the patients'CHA2DS2-VASc score and offer timely psychological counselling to minimize their risk of developing depression and improve their quality of life.