| Objective:We aimed to evaluate the therapeutic effect of radiofrequency ablation on atrial fibrillation patients complicated with left ventricular hypertrophy,and analyze the influencing factors of postoperative left ventricular reverse remodeling,and provide reference for clinical treatment and management.Methods:120 atrial fibrillation patients complicated with left ventricular hypertrophy(LVEDI?33mm/m~2)were enrolled,which were treated with RFCA.Ensite Nav X or CARTO three-dimensional mapping system was used to perform endocardial electrophysiological examination and radiofrequency ablation.General information,results of preoperative echocardiography,results of cardiac magnetic resonance,results of preoperative blood routine test,biochemical and coagulation function were collected.Echocardiography was performed before operation,and the following indicators were collected:left atrial diameter(LAD),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVED),left ventricular end systolic diameter(LESD),and left ventricular end diastolic diameter index(LVEDI).Preoperative CMR examination was performed to determine the proportion of LGE region of myocardium,and?1%was defined as LGE positive.Preoperative blood routine and biochemical and coagulation function indicators were collected,including red blood cell distribution width(RDW),platelet distribution width(PDW),neutrophil and lymphocyte ratio(NLR),hypersensitive c-reactive protein(hs CRP),fibrinogen and albumin ratio(FAR),and concentration serum N-terminal pro-brain natriuretic peptid(NT-pro BNP).Echocardiography was performed 6 months after operation,and the collected metrics were as the same as the preoperative indicators.Definition of reverse remodeling was determined as follows:(1)the postoperative LVEDI decreased?10%,or the postoperative LVEDI?33mm/m~2;(2)postoperative LVEF?50%.Preoperative and postoperative echocardiographic indexes were compared.Baseline data were compared between reverse remodeling group and control group.Logistic regression was used to analyze the influencing factors of postoperative adverse cardiac reverse remodeling in patients,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of relevant indicators on left ventricular reverse remodeling.Results:(1)The mean age of 120 patients was(61.28±8.77)years,53 patients were paroxysmal,57 patients were persistent,and the mean height and weight was(162.65±7.96)cm and(62.41±10.39)kg respectively.(2)53 cases had reverse remodeling(reverse remodeling group),accounting for 44.17%,and 67 cases did not achieve reverse remodeling(control group),accounting for 55.83%.Preoperative LAD,LVED,LVSD,LVEDI and LVEF were(46.08±5.85)mm,(58.99±4.42)mm,(37.73±6.93)mm,36.25±3.60,60.56%±11.25%,respectively,which were(40.46±6.45)mm,(52.57±5.85)mm,(32.48±5.48)mm,32.36±4.63,61.93%±14.19%6 months after operation.LAD,LVED,LVSD and LVEDI all decreased significantly(P<0.05),while LVEF did not change significantly(P>0.05).(3)Univariate analysis showed that the average age of patients in the reverse remodeling group was significantly higher than that in the control group(P<0.05),and the proportion of paroxysmal atrial fibrillation was lower(P<0.05).Preoperative LVED and LVEDI in the reverse remodeling group were significantly lower than those in the control group(P<0.05),and preoperative LAD was significantly higher than those in the control group(P<0.05).The course of atrial fibrillation in the reverse remodeling group was significantly greater than that in the control group(P<0.05).The positive ratio of LGE in the reverse remodeling group was significantly lower than that in the control group(P<0.05).RDW,PDW,NLR,hs CRP and FAR in the reverse remodeling group were significantly lower than that in the control group(P<0.05).There was no statistical significance for other indicators(P>0.05).(4)Conditional logistics regression analysis showed that age,course of atrial fibrillation,LAD,LVEDI,LGE positive,hs CRP,PDW,FAR and NLR were independent factors for reverse remodeling after radiofrequency ablation in patients with atrial fibrillation and left ventricular hypertrophy.(5)The area under curve(AUC)of LAD,LVEDI,NLR,PDW,FAR and hs CRP,that were used for predicting left ventricular reverse remodeling in patients with atrial fibrill ation complicated with left ventricular hypertrophy after radiofrequency ablation was0.666(95%CI 0.569?0.763),0.714(95%CI 0.622?0.806),0.821(95%CI 0.746?0.897),0.774(95%CI0.692?0.856),0.769(95%CI 0.686?0.852)and 0.607(95%CI0.505?0.708),respectively,which shows that ROC curve has statistical significance(P<0.05).The optimal threshold for LAD to predict reverse remodeling was 49.5,and the corresponding sensitivity and specificity were 41.5%and 83.6%respectively.The optimal threshold for LVEDI to predict reverse remodeling was 36.25,and the corresponding sensitivity and specificity were 84.9%and 58.2%respectively.The optimal threshold for hs CRP to predict reverse remodeling was 1.15,and the corresponding sensitivity and specificity were 71.7%and 85.1%respectively.The optimal threshold for PDW to predict reverse remodeling was 20.52,and the corresponding sensitivity and specificity were 86.8%and 56.7%respectively.The optimal threshold for FAR to predict reverse remodeling was 7.38,and the corresponding sensitivity and specificity were 96.2%and 44.8%respectively.The optimal threshold for NLR to predict reverse remodeling was 2.407,and the corresponding sensitivity and specificity were 88.7%and 37.3%,respectively.Conclusions:(1)Radiofrequency ablation can effectively induce left ventricular reverse remodeling in patients with atrial fibrillation complicated with left ventricular hypertrophy.(2)The realization of reverse remodeling of left ventricle in patients with atrial fibrillation with left ventricular hypertrophy after radiofrequency ablation is affected by various factors,including age,size of left atrium,degree of left ventricular remodeling and inflammatory biomarkers which can be used as predictors of whether patients can achieve reverse remodeling after ablation and reference for clinical treatment and management. |
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