To Compare The Risk And Efficacy Of Catheter Radiofrequency Ablation On Persistent Atrial Fibrillation Patients With Decreased LVEF And Normal LVEF

Objective:Atrial fibrillation and heart failure are common heart diseases in medical work and have a high incidence.They have some common risk factors,affect each other,and effect quality of survival.The treatment of patients with atrial fibrillation and heart failure appears to be very important.With the development and maturity of catheter radiofrequency ablation technology,it is gradually applied to patients with atrial fibrillation and heart failure,and more studies have shown that such patients can benefit from catheter ablation.On this basis,we studied the change of cardiac function and structural indexes after catheter ablation in patients with persistent atrial fibrillation owning different LVEF.To compare the risk and efficacy of Catheter Radiofrequency Ablation on persistent atrial fibrillation patients with normal cardiac function and dysfunction.Method:Two hundred Persistent Atrial Fibrillation patients who underwent Catheter Radiofrequency Ablation in the Affiliated Hospital of Qingdao University from February2015 to February 2018 were enrolled.They were divided into experimental group and control group according to LVEF level measured by cardiac ultrasound before Catheter Radiofrequency Ablation.The experimental group was divided into two subgroups of group A and group B according to LVEF level.Group A is persistent AF patients with LVEF < 40%,group B is persistent AF patients with LVEF between 40% and 49%,and Group C was persistent AF patients with LVEF ≥ 50%.Firstly,Recording left atrial modeling time,ablation time,and total operative time,intraoperative acute heart failure,other atrial arrhythmias(RATs),cerebrovascular events,pericardial effusions,average hospitalization day,average hospitalization expenses in three groups.Compared whether the above indicators are statistically different between patients in group A and group C,group B and group C,and patients in group A and group B.Secondly,Recording left atrial anterior-posterior diameter(LAD),left ventricular end-diastolic long-term diameter(LVEDd),left ventricular ejection fraction(LVEF),and NYHA cardiac function grading of Persistent Atrial Fibrillation patients who received the Catheter Radiofrequency Ablation,then compare the change before and 3 months,6 months,and 12 months after the operation.Follow-up of 12 months after the operation,patients were divided into two groups of successful group and failure group.comparing the preoperative indexes(gender,age,duration of atrial fibrillation,ventricular rate,NYHA cardiac function grading,LAD,LVEF,NRL,Pd)between the successful and failure groups to study whether they can be the predicting factors of recurrence after the Catheter Radiofrequency Ablation.Results:1.The general data of the three groups,such as age,gender,history of hypertension are without the statistic significance(P>0.05).LAD,LVEF,NRL,LVEDd,duration of atrial fibrillation,and NYHA cardiac function grade of three groups are significantly different(P<0.05).2.There were no significant differences in left atrial modeling time,and total operative time between the three groups(P>0.05).3.The incidence of RATs,group A and group B(3/20 vs.1/65,P<0.05),group A and group C(3/20 vs.3/115,P<0.05);patients with acute heart failure,group A and group B(5/20 vs.4/65,P<0.05);One case of TIA occurred in group A,and no cerebrovascular events occurred in group B and group C.4.Compared with pre-operation,after 6 months,the A group showed LVEF increased(37.1±1.4 vs.40.7±2.4,P<0.05),LAD decreased(45.5±1.9 vs.44.2±2.1,P<0.05),and LVEDd decreased(53.8±3.4 vs.51.2±3.6,P<0.05),NYHA cardiac function grade decreased(2.5±0.6 vs.2.0±0.3,P < 0.05).Compared with pre-operation,after 3 months,the B group showed LVEF increased(45.7±2.3 vs.47.8±3.9,P<0.05),NYHA cardiac function grade decreased(1.9±0.6 vs.1.5±0.5,P<0.05).After 6 months LAD decreased(43.5±1.7 vs.42.5±3.6,P<0.05),LVEDd decreased(51.8±4.8 vs.50.1±4.6,P<0.05).There was no statistical difference between the above-mentioned indexes in group C.5.There was no significant difference in the rate of rehospitalization between the three groups after 6 months.But after 12 months,group A and group C(12/20 vs.35/115,P>0.05).In group A,the successful rate was 75.00% after 6 months,and 45.00% after 12 months.In group B was 80.00% after 6 months,and 61.54% after 12 months.In group C was 81.74% after 6 mouth,and 69.57% after 12 months.The success rate of group A after12 months was significantly lower than that of the other two groups(P<0.05).6.Univariate statistical analysis showed that late recurrence was associated withduration of atrial fibrillation,LVEF,LAD,NRL,and immediate postoperative electrocardiogram Pd(P<0.05),which can be used as indicator to assess the risk of recurrence after radiofrequency ablation of continuous atrial fibrillation.Conclusion1.Radiofrequency ablation is an effective treatment for persistent AF.The left atrial structure can be remodeling after sinus rhythm recovery.For patients with LVEF decline,the cardiac structure and function index are significantly improved after operation.However,for other patients,the change was not obvious after surgery.2.Persistent AF patients with LVEF <40% benefited from radiofrequency ablation.It can improve cardiac structure and function,reduce the rate of rehospitalization.But acute heart failure,RATs and cerebrovascular events occurred during surgery.The risk is high and may be associated with fewer cases in this study.3.Contrast patients with LVEF <40% and LVEF ≥40%,the success rate of the former will be lower than the latter with the extension of follow-up time.4.The duration of atrial fibrillation,preoperative LVEF,LAD,NRL,and Pd have certain value for predicting postoperative recurrence of persistent AF.