Correlation Between Left Atrial Pressure Changes And Postoperative Recurrence In Patients With Atrial Fibrillation Undergoing Radiofrequency Ablation

Objective: To study the changes of left atrial pressure before and after radiofrequency ablation in patients with different types of atrial fibrillation,and to explore the relationship between left atrial pressure and recurrence of atrial fibrillation within 6 months after radiofrequency ablation of atrial fibrillation.Method:Patients with atrial fibrillation who were hospitalized for the first time in our department from December 2017 to October 2018 and successfully underwent RFCA were divided into two groups according to the type of atrial fibrillation: paroxysmal atrial fibrillation and persistent atrial fibrillation.The left atrial pressure before and after radiofrequency ablation and the recurrence at 6 months after radiofrequency ablation were compared.Multivariate regression analysis was used to determine whether left atrial pressure changes were associated with recurrence of AF at 6 months postoperatively.Results:A total of 84 patients with atrial fibrillation were enrolled in the study,including 52 patients with paroxysmal atrial fibrillation and 32 patients with persistent atrial fibrillation.Six months after radiofrequency ablation,12 patients(14.3%)relapsed with atrial fibrillation.Compared with the paroxysmal atrial fibrillation group,the proportion of men with persistent atrial fibrillation is greater.Patients with persistent atrial fibrillation have higher white blood cell count(WBC),larger left atrial diameter(LAD),and left ventricular ejection fraction.(LVEF)lower,peak systolic blood flow velocity(E)and mitral annulus early diastolic peak velocity(e')ratio(E/e'),left atrial appendage blood flow evacuation rate(LAA-FEV)was lower and the proportion of patients with recurrence was higher,and the difference was statistically significant.Compared with patients with LAD<40mm group,patients with LAD?40mm had greater LV,lower LVEF,greater E/e',higher Preoperative LAP and post-LAP,and the differences were statistically significant.Compared with the <10mmHg group before LAP,the left atrial diameter of patients with ?10mmHg before LAP was positively correlated with LAP,and there was a negative correlation between LVEF and LAP.However,there was no significant difference in Preoperative LAP,post-LAP,and ?LAP between the paroxysmal group and the continuous group.Univariate logistics analysis showed that atrial fibrillation type?age and LAD was a contributing factor to the recurrence of atrial fibrillation.Multivariate logistic regression analysis showed that LAD?age and type of AF was an independent risk factor for recurrence of atrial fibrillation.Conclusion:1.The left atrial diameter,left ventricular ejection fraction,and left atrial pressure have a good correlation and can be used as a non-invasive parameter for predicting left atrial pressure.2.Patients with persistent atrial fibrillation have a greater chance of recurrence after surgery in patients with paroxysmal atrial fibrillation.Active treatment of paroxysmal atrial fibrillation in clinical work,prevention and avoidance of conversion to persistent atrial fibrillation for patients with atrial fibrillation has important clinical significance.3.There was no significant difference in left atrial pressure during radiofrequency ablation of patients with paroxysmal atrial fibrillation and persistent atrial fibrillation.No change in left atrial pressure was directly associated with recurrence of AF at 6 months postoperatively.4.Left atrial diameter is an independent risk factor for recurrence of atrial fibrillation after transcatheter radiofrequency ablation.It may be necessary to adopt a more aggressive ablation strategy for patients with larger left atrial diameter.