| Objective: Atrial fibrillation(AF),as one of the most common arrhythmia in China,has the extremely high disabling and deadly,serious affecting people's life quality.Recently,with the continuous development of electrophysiological technique,catheter ablation of atrial fibrillation technology get more and more favour of people.But there is no conclusion about the changes of biomarkers after different catheter ablation and its predictability on AF recurrence.The above questions will be discussed in this experiment.Method:Two hundred and ten patients with paroxysmal AF hospitalized at the Second Hospital of Hebei Medical University between March 1st 2016-March 1st 2017 were enrolled in this study.All patients were treated with catheter ablation on AF,which includes radiofrequency ablation,cryoablation and 3D guided cryoablation.All patients were taken blood sample pre-operation and 1 day,2 days,3 days,1 week,2 weeks,3 weeks,4 weeks,2 months and 3 months after ablation,aiming to test the white blood cell count(WBC),neutrophilic granulocyte percentage(NE%),neutrophil count(NE num),lymphocyte percentage(LY%),lymphocyte count(LY num)and high-sensitivity C-reactive protein(hs-CRP).Besides,patients were arranged to review Holter 2 months,3 months,6 months,1 year after the operation.Meanwhile,patients with symptoms such as palpitations,chest distress,timely go to the doctor and do 12 conductor table electrocardiogram(ECG),according to which we record whether a atrial arrhythmia,which includes premature atrial contraction,atrial tachycardia,atrial flutter and AF,occurs during the follow-up period.Results: there are totally 210 patients enrolled in this experiment,with 70 patients in cryoablation group(CA Group),radiofrequency group(RF group)and 3D guided cryoablation group(CA 3D group)respectively.Groups of patients based on age,gender,comorbidity,etc were no statistical difference.All of the patients in the process of catheter ablation were completed in the pulmonary vein isolation,and converted to sinus rhythm.There is no thromboembolism,tamponade complications during the perioperative period.1 Changes of inflammation biomarkers and comparison among 3 groups 1.1 White blood cell count(WBC)RF group: the WBC began to increase after the ablation,and reached a peak value on the 1st day post-ablation(P<0.05).On the 3rd day post-operation,it fell back to pre-operation level(P>0.05).Then it rerose one week after operation and fell back to the pre-operation level 2 months after the operation finally.CA Group and CA 3D group: the WBC also started rising after the ablation,and reached a peak value on the 1st day post-ablation,while WBC fell 2nd and 3rd day post-operation,but was still above the pre-operative level(P<0.05).On 1 week after the operation,WBC rebound again,and finally fell back to pre-operation level on the 3rd week after operation.Compared with the RF group,the patients in the CA Group and CA 3D group had a higher peak level of WBC(P<0.05),among which the highest level was in the CA Group,but there was no statistical difference between the two groups.In terms of duration,WBC of the CA Group and the CA 3D group showed a rapid decline,both falling back to the preoperative level 3 weeks after surgery,while the inflammation of RF group showed a longer duration,falling back at 2 months after surgery.1.2 Neutrophils percentage(NE%)RF group: the level of NE% in this group increased after the ablation,and reached a peak value on the 1st day post-ablation(P<0.05),and then fell back to the preoperative level 3 days after surgery(P>0.05).It rose again 1 week and finally returned to the pre-operation level 3 weeks after surgery.After that, the level of NE% was relatively stable without statistical difference(P>0.05).CA Group: the level of NE% in this group reached the peak on the first day after operation(P<0.05),and then fell back to the preoperative level on the 3rd day(P>0.05).It rose again 1 week,and finally fell back to the preoperative level 3 weeks after surgery.After that,the NE% showed a downward trend,but there was no statistical difference compared with that before surgery(P>0.05).CA3 D Group: in this group,the level of NE% also increased after the ablation,and reached a peak value on the 1st day post-ablation,and slightly decreased on the 2nd and 3rd day,but it was still higher than the preoperative level,recovered at 1 week,and finally fell back to the preoperative level at 3 weeks after surgery(P>0.05),and then the level of NE% leveled off without statistical difference.Compared among the three groups,the post-operative NE% of the patients in the three groups showed the highest peak value in CA 3D group,while the lowest value in RF group.There was no statistical difference between CA 3D and CA Group(P>0.05).In terms of duration,NE% of the three groups finally fell back to the preoperative level 3 weeks after surgery,and then tended to be stable,with no significant difference.1.3 Neutrophils count(NE num)RF group: the NE num in this group began to increase after the ablation,and reached a peak value on the 1st day post-ablation(P<0.05),and fell back to the preoperative level on the 3rd day,then rose again 1 week after the surgery,finally fell back to the preoperative level 3 weeks after the surgery,and tended to be stable.CA Group and CA 3D group: the two groups also increased after the ablation,and reached a peak value on the 1st day post-ablation(P<0.05),NE num after 2 days,3 days can be a slight decline,but was still above the level of the preoperative(P<0.05).Then Ne num rerose again on 1 week postoperation,and eventually returned to normal after 3 weeks,then leveled off NE num,and no statistical difference(P>0.05)when compared with preoperative level.Comparison among the three groups,NE num increased most significantly in CA Group,followed by CA 3D group,and RF group had the lowest degree of increase,while there was no statistical difference between CA Group and CA 3D group,or between CA 3D group and RF group(P>0.05).In terms of duration,the three groups finally returned to the preoperative level 3 weeks after surgery,and RF group showed a decline 3 days after surgery,with no statistical difference compared with the preoperative level.1.4 Lymphocyte percentage(LY%)LY% in the three groups started to decrease after the operation and reached the lowest value 1 day after it(P<0.05),and increased on the 2nd and 3rd day,but it was still lower than the preoperative level(P<0.05).It decreased again 1 week after surgery,and finally rose to the preoperative level on the 3rd week.After that,LY% in the three groups was stable and had no statistical difference from that before surgery.Comparison among the three groups,the LY% lowest level was found in CA Group,reducing the most significant,followed by CA 3D group,and the highest level was in RF group,of which both the two contrast between three groups with statistical difference(P<0.05).In duration,the three groups fell down in 1 day to reached the lowest,and eventually recovered to preoperative levels on postoperative 3 week,no obvious difference was found.1.5 Lymphocyte count(LY num)RF group: the LY num in this group began to decrease after the operation and reached the lowest value on the first day(P<0.05).It recovered to the preoperative level on the 2nd day and decreased again on 3rd day after the operation,but there was no statistical difference(P>0.05).After that,LY num increased slowly and reached the highest value on the 3rd month after the operation,which was statistically different from that before the operation(P<0.05).CA Group and CA3 D group: the LY num in the two groups also began to decrease after the operation and reached the lowest value 1 day after ablation,and recovered to the preoperative level on the 3rd day.After that,the absolute value of LY fluctuated up and down,but there was no statistical difference compared with the preoperative level(P>0.05).Comparison among the three groups,among the three groups of patients with the lowest value of LY num,RF group showed the most significant decrease,followed by CA Group,followed by CA 3D group,but there was no statistical difference between the three groups in pairwise comparison(all P>0.05).In terms of duration,the RF group was shorter than the other two groups,and recovered to the preoperative level 2 days after surgery,while the latter 2 recovered to the preoperative level 3 days after surgery.1.6 Neutrophil/lymphocyte ratio(NLR)CA Group and RF group: NLR in the two groups began to rise after the operation and reached the peak value on the 1st day(P<0.05),then it began to fall on the 2nd day and fell back to the preoperative level on the 3rd day after the operation.It rose again on one week and finally fell back to the preoperative level three weeks after the operation.After that,NLR level fluctuated up and down,but there was no statistical difference compared with the pre-operative level.CA3 D group: NLR also reached the peak value 1 day after the operation(P<0.05),and slightly decreased on the 3rd day,but it was still higher than the preoperative level(P<0.05).It increased again 1 week after the operation,and finally fell back to the preoperative level on the 3rd week post-operation.After that,the NLR level also fluctuated up and down,but there was no statistical difference compared with that before the operation.Comparison among the three groups,on the peak level among the three groups,the increase was most significant in CA Group,followed by CA3 D group,and was relatively mild in RF group,but there was no significant statistical difference among the three groups in pairwise comparison.In terms of duration,the NLR of the three groups finally returned to the preoperative level 3 weeks after the surgery,among which CA Group and RF group returned to the preoperative level 3 days after the surgery,with significant changes in the first 3 days after the surgery.1.7 High-sensitivity C-reactive protein(hs-CRP)RF group: hs-CRP began to increase after the ablation,the level of hs-CRP of the 1st day post-ablation was found with statistical difference from pre-operative level(P<0.05),and reached a peak on the 3rd day(P<0.05).Then hs-CRP level rapidly decreased on the 1st week,and finally fell back to the preoperative level on the 2nd week post-operation(P>0.05).After that,hs-CRP was relatively stable,with no statistical difference compared with the preoperative level.CA Group: hs-CRP overall level is lower than RF group.The hs-CRP began to rise on the 1st postoperative day,but no difference(P>0.05)compared with preoperative level.It decreased slightly 2 days after the operation,reached a peak on the 3rd day(P<0.05),and finally fell back to the preoperative level 2 weeks after the operation,followed by a slow decline to 2 months,and then rose again on the 3rd month,but there was no statistical difference with that before the operation.CA3 D group: it began to rise 1 day after surgery,reached a peak 1 week after surgery(P<0.05),and fell back to the preoperative level on the 2nd week post-operation.After that,the hs-CRP level fluctuated up and down,but there was no difference compared with that before surgery.Comparison among the three groups,the hs-CRP peak value increased most significantly in RF group,followed by CA3 D group,and the increase was relatively mild in CA Group.In terms of the increasing trend,all the patients in the three groups began to rise one day after surgery,while the hs-CRP level in CA Group and CA3 D group showed no statistical difference compared with that before surgery,while the increase in RF group was more significant,showing a statistically significant difference compared with that before surgery.As for the peak time,both the CA Group and RF group reached the peak value 3 days after the surgery,while CA3 D group increased to the peak value 1 week after the surgery,lagging behind the other two groups.In terms of duration,all three groups recovered to the preoperative level 2 weeks after surgery,but among the three groups,the RF group showed the most rapid decrease in inflammatory indicators.2 Recurrence of AF We define the early recurrence of AF as atrial arrhythmias with time of duration greater than 30 s occurred within 3 months after the operation,which includes atrial tachycardia,atrial flutter and atrial fibrillation.Late recurrence of AF was defined as atrial arrhythmias occurred more than 3 months after surgery.Total recurrence was defined as all episodes of recurrence after catheter ablation.If both short-term and long-term recurrence occurred in the enrolled patients,the total recurrence was defined as 1 case.In terms of recurrence,there were 7 patients(10.0%)with early recurrence in CA Group,14 patients(20.0%)with late recurrence,and a total of 14 patients(20.0%)with recurrence.There were 5 patients(7.1%)with early recurrence and 5 patients(7.1%)with late recurrence in CA 3D group,and a total of 9 patients(12.9%)with recurrence.In RF group,there were 7 patients(10.0%)with ealy recurrence,15 patients(21.4%)with late recurrence,and a total of 16 patients(22.9%)with recurrence.Pearson chi-square test shows no statistical difference in ealy recurrence rate among the three groups(P=0.793).In the late recurrence rate and total recurrence rate,CA3 D group was superior to the other two groups,with statistical difference(P<0.05),while there was no statistical difference between CA Group and RF group(P>0.05).3 Relationship between inflammatory biomarkers and recurrence of AF Inflammation markers were taken the difference value between peak and preoperative level as observation indexes,namely,the WBC,NE %,NE num,LY %,LY num,NLR take the difference in value between the preoperative and postoperative 1st day,hs-CRP take the difference in value between the preoperative and postoperative 3rd day.Among all the difference values,the values conform to the normal distribution curve of the Logistics regression analysis,which does not conform to the normal distribution curve of Spearman correlation analysis.The total recurrence rate was positively correlated with the difference between WBC and NE% and preoperative values 1 day after surgery(P<0.05).Early recurrence was positively correlated with the difference between NE% on 1st day after surgery and preoperative value(P<0.05),while LY% on 1st day after surgery was negatively correlated with preoperative value(P<0.05).Late recurrence was positively correlated with NE% on 1st day and preoperative difference,and was not correlated with other observation indicators(all P>0.05).Conclusion: 1.After cryoablation,radiofrequency ablation and 3D guided cryoablation,there were obvious inflammatory reactions,which were reached the peak value during the 1st to 3rd day post-operation.The peak value and falling time of inflammatory indicators caused by different catheter ablation methods were different.2.The late recurrence rate and total recurrence rate of CA3 D group in paroxysm atrial fibrillation were lower than that of RF group and CA Group.There was no significant difference between the latter two.3.The NE% difference between preoperative and preoperative level after catheter ablation can predict the early and late recurrence of AF,while the LY% difference between the preoperative and preoperative level is correlated with early recurrence,while the increase of WBC is only correlated with the overall recurrence of AF. |
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