Relationship Between The Characteristics Of P-ring Of Stereo Electrocardiogram And Left Atrial Function Monitoring Under Ultrasound In Patients With Paroxysmal Atrial Fibrillation And The Recurrence

Objective:To identify parameters of left atrial function with three-dimensional electrocardiogram and echocardiography predicting recurrence of paroxysmal atrial fibrillation(PAF)after radiofrequency ablation(RFCA)..Methods:One hundred and twenty patients diagnosed with PAF undergoing RFCA were studied.Patient demographics were collected.The P wave dispersion(PWDIS),the P wave amplitude(PWA)and the P wave duration(PWD)were measured by stereoscopic electrocardiogram(three dimensional electrocardiogram),and the left atrial maximum volume index(LAVImax),the left atrial minimum volume index(LAVImin),the left atrial diameter(LAD),the left ventricular ejection fraction(LVEF)and the ratio(E/E')of early diastolic transmitral velocity(E)to early mitral anulus diastolic velocity(E')were measured by echocardiography..All patients underwent RFCA with conventional pulmonary vein isolation.Oral anticoagulation therapy was continued for?3 months in all patients.Thereafter,whether to continuing anticoagulation therapy was based on the patient's CHADS2 score.Antiarrhythmic drug(AAD)was discontinued 3 months after RFCA.Follow-up(symptoms and 24-h or 7-d Holter)was performed from 3 to 12 months thereafter.Results:A total of 120 patients with PAF were enrolled(male:female=68:52).There were 35 patients in the recurrence group(male:female=15:20)and 85 patients in the non-recurrence group(male:female=53:32).There were no significant differences in age,sex,height,weight or smoking history between the two groups.However,the duration of disease(16.0±6.5 vs 8.3±4.0 months,P=0.000),BMI(24.9±2.5 vs 22.6±1.8kg/m~2,P=0.043),TC(4.10±1.14 vs 4.44±0.82 mmol/l,P=0.019),hypertension(27/35vs 40/85,P=0.003),and diabetes(7/35 vs 5/85,P=0.036)were all P<0.05,with statistically significant differences between the groups.Preoperative LAVImax(38.6±5.5vs 28.8±3.2 ml/m~2,P=0.000),preoperative LAD(44.6±4.5 vs 33.4±5.2 mm,P=0.040),and preoperative E/E'(10.5±1.7 vs 8.3±0.9,P=0.001)were significantly higher in the recurrence group than in the non-recurrence group.The difference of preoperative PWD(123.5±6.4 vs 105.7±5.1 ms,P=0.012)and preoperative PWDIS(55.9±6.5 vs 42.1±3.5ms,P=0.000)between the recurrence group and the non-recurrence group was statistically significant.The preoperative LAVImin,LVEF and PWA were not statistically significant between the two groups.Postoperative LAVImax in the recurrence group was significantly higher than that in the non-recurrence group(38.9±5.3 vs 28.2±3.3 ml/m~2,P=0.017),and the difference was statistically significant.There were significant differences in postoperative LAD(45.1±4.9 vs32.5±5.1 mm,P=0.028)and postoperative E/E'(10.6±1.9 vs 7.8±0.8,P=0.003)between the recurrence group and the non-recurrence group.The postoperative PWD(124.1±6.0vs 103.3±4.5 ms,P=0.023)and postoperative PWDIS(56.2±7.2 vs 41.8±3.3 ms,P=0.015)of the recurrence group were significantly higher than that of the non-recurrence group(both P<0.05),and the difference between the two groups was statistically significant.There is a correlation between echocardiography and electrocardiology.LAVImax(r=-0.526,P<0.05),LAVImin(r=-0.568,P<0.05),LAD(r=-0.549,P<0.05),E/E'(r=-0.398,P<0.05)were negatively correlated with PWA.LAVImax(r=0.715,P<0.05),LAVImin(r=0.799,P<0.05),LAD(r=0.682,P<0.05),E/E'(r=0.595,P<0.05)were positively correlated with PWD.LAVImax(r=0.810,P<0.05),LAVImin(r=0.853,P<0.05),LAD(r=0.778,P<0.05),E/E'(r=0.603,P<0.05)were positively correlated with PWDIS.LVEF was positively correlated with PWA(r=0.503,P<0.05),and negatively correlated with PWD(r=-0.679,P<0.05)and PWDIS(r=-0.814,P<0.05).According to ROC curve analysis,the accuracy of PWD in predicting postoperative af recurrence was the highest(the area under the curve was 0.986,the sensitivity was 88.6%,the specificity was 97.6%,and the critical value was 115.9ms).Conclusion:Duration of disease,BMI,TC,hypertension,diabetes,LAD,LAVImax,E/E',PWD and PWDIS are important indicators for predicting the recurrence of patients with PAF after RFCA,with the highest accuracy of PWD prediction.Echocardiography and electrocardiography are closely related to each other.Both of them reflect left atrial function and are good non-invasive techniques for predicting recurrence of AF.It is convenient to judge the prognosis of patients with PAF and choose the best treatment.