Predictive Value Of Monocyte/HDL-C Ratio For Late Recurrence Of Paroxysmal Atrial Fibrillation After Radiofrequency Ablation

Background: Atrial fibrillation(AF)is a kind of rapid arrhythmia characterized by the extremely disordered atrial electrical activity.The incidence rate of atrial fibrillation is increasing with age.With the development of global aging,the incidence of atrial fibrillation will continue to increase and will further burden social economy and medical care.The emergence of catheter ablation technology has changed the current situation of the treatment of AF.With the development of ablation device and ablation strategy,the research progress of AF catheter ablation is quite fruitful.Some studies report that there is still a high risk of late recurrence of AF after the first catheter ablation,and some even need repeated ablation.In recent years,a large number of studies focused on reporting the clinical factors that affect the success of ablation,in order to achieve the accurate prediction of the recurrence of AF after radiofrequency ablation,in order to screen the clinical appropriate surgical patients,effectively identify high-risk patients before surgery and timely intervention in postoperative follow-up,and then further improve the long-term effect of catheter ablation.Objective: To explore the clinical value of the ratio of monocyte to HDL-C and the diameter of left atrium in predicting the late recurrence of paroxysmal AF after radiofrequency ablation.Methods: From April 2015 to October 2018,patients with paroxysmal atrial fibrillation who met the indications of radiofrequency ablation in the cardiology department of the people's Hospital of Northern Jiangsu Province were selected.The clinical data of the patients were collected before the operation,including the history,blood test results,echocardiography and other indicators.During the follow-up period from November 2019 to November 2019,long-term wearable single lead Holter,Holter or 12 lead Holter were used to detect atrial arrhythmia in patients after operation.According to the late recurrence of AF after catheter ablation(within 3 months),the patients were divided into two groups: the late recurrence group and the maintenance of sinus rhythm group.The clinical data such as the ratio of monocyte to HDL-C,the diameter of left atrium and so on were compared between the two groups,and the single factor statistical analysis was carried out to explore the clinical factors that increase the risk of late recurrence of AF after catheter ablation.Furthermore,the index of P < 0.05 in single factor statistical analysis were enrolled in the multivariate logistic regression analysis model to further explore the independent and reliable clinical risk factors of late recurrence of AF.The working characteristic curve(ROC)of the subjects whose monocyte to HDL-C ratio and left atrial diameter predicted the late recurrence of AF after operation was drawn and the area under the curve(AUC)was calculated to evaluate the clinical value of predicting the late recurrence of AF after radiofrequency catheter ablation.Results: A total of 125 cases of paroxysmal atrial fibrillation were included,56 of which were female.The statistical analysis showed that the average age of the patients was(61.2 ± 9.3)years old.The regular follow-up was(25.1 ± 12.0)months up to November 2019.47 patients had late recurrence,and the late recurrence rate was 37.6%.The ratio of monocyte to HDL-C ?8.29(4.99)vs 6.34(3.39),P = 0.000? and the diameter of left atrium?(37.70 ± 4.10)mm vs(34.20 ± 3.80)mm,P = 0.000? were significantly higher in the group of recurrent AF than in the group of maintaining sinus rhythm after ablation.In addition,the duration of AF,history of diabetes,BMI,monocyte and HDL-C in patients with advanced recurrence were significantly higher than those in patients with sinus rhythm maintenance(P < 0.05).There was no significant difference in age,history of hypertension,history of coronary heart disease,history of stroke,female proportion,e GFR,CHA2DS2-VASc score,leukocyte count,neutrophils,lymphocytes,left ventricular ejection fraction,LDL-cholesterol,uric acid and other data between the late recurrence group and the postoperative maintenance of sinus rhythm(P > 0.05).The course of AF,the history of diabetes,BMI,monocyte,HDL-C,the ratio of monocyte to HDL-C and the diameter of left atrium were used as independent variables to adjust the course of AF,the history of diabetes,BMI,monocyte and HDL-C After alcohol and other related factors,the diameter of left atrium(OR = 1.21,95% CI = 1.08-1.35,P = 0.001),the ratio of monocyte to high-density lipoprotein cholesterol(OR = 1.34,95% CI = 1.12-1.60,P = 0.001)independently increased the risk of late AF recurrence.In addition,the ratio of monocytes to HDL-C and left atrial diameter showed a good positive correlation(r = 0.229,P = 0.01).ROC analysis showed that the ratio of monocyte to HDL-C predicted the AUC of late recurrence after RFA was 0.712(95% CI = 0.618-0.806,P = 0.000).The best cutoff value was 8.88.The sensitivity and specificity of reliable prediction of late recurrence of AF were 44.7% and 85.9%,respectively.The predictive value of left atrial diameter for late recurrence after RFA was 0.739(95% CI = 0.653-0.814,P = 0.000).The best cutoff value was 35.5mm.The sensitivity and specificity of reliable prediction of late recurrence of AF were 74.5% and 65.4%,respectively.Z test showed that there was no significant difference between monocyte / HDL-C ratio and left atrial diameter under ROC curve(Z = 0.451,P = 0.6523).Conclusion: The monocyte to HDL-C ratio and the diameter of left atrium independently and reliably increased the risk of late recurrenc after radiofrequency ablation of paroxysmal atrial fibrillation.There was no significant difference between the clinical value of monocyte / HDL-C ratio and the left atrial diameter in predicting the late recurrence of AF after ablation.