The Associations Between Trimethylamine N-oxide Levels And Early Recurrence Of Paroxysmal Atrial Fibrillation After Radiofrequency Catheter Ablation

Objective: Atrial fibrillation(AF)is one of the most common tachyarrhythmia disorders.the incidence of which is increasing year by year.At present,circumferential pulmonary vein isolation ablation has been the most popular and effective method for the treatment of atrial fibrillation.However,the recurrence rate of ablation is still very high,so how to reduce the recurrence of atrial fibrillation after catheter ablation has become the focus of electrophysiological experts.Trimethylamine n-oxide(TMAO)is a metabolite of intestinal flora.In recent years,a large number of studies have confirmed that intestinal flora plays an important role in the occurrence and development of coronary atherosclerotic heart disease,hypertension and heart failure.Previous studies have also demonstrated that TMAO promotes inflammatory response and maintains the development of AF.This prospective study is to investigate the association of TMAO with the risk of early recurrence of AF after radiofrequency catheter ablation(RFCA).Methods: This study enrolled 83 consecutive patients who underwent circumferential pulmonary vein ablation in the second Hospital of Hebei Medical University from January 2019 to September 2019 and 40 persons underwent medical test without AF at the same time as control group.Gender,age,BMI,smoking history,alcohol history,hypertension,diabetes,creatinine,transaminase,LDL cholesterol,left ventricular ejection fraction,and left atrial diameter were recorded in detail.Venous blood was collected preoperatively for serum TMAO measurement before RFCA,and the patients were followed up for 3 months to identify the recurrence of AF via monthly 12-lead ECG and 24 h Holter recordings.According to the follow-up results,all patients were divided into the non-recurrence group(58 cases)and the recurrence group(25 cases).Results: The control group and AF group had similar distribution of most characteristics except for TMAO level(P<0.001)and LAD(P<0.001).A total of 83 patients with AF underwent radiofrequency ablation,all of whom completed circumferential pulmonary vein electrical isolation.Compared with the control group,the atrial fibrillation group had a higher LAD(P<0.001)and a higher serum TMAO level(P<0.001)with statistically significant differences.The TMAO level of the recurrence group was significantly higher than that of the non-recurrence group(5.68±1.42 vs.4.55±1.09umol/L,P<0.05).After 3 months follow-up,25 patients had recurrence after radiofrequency ablation,with a recurrence rate of 30.12%.Univariate logistic analysis of all variables showed that there were significant differences in LDL-C,LAD and TMAO(P<0.05).Multivariate logistic regression analysis of LDL-C,LAD,and TMAO showed that LAD(P=0.003,OR=1.300,95%CI: 1.092-1.547)and TMAO(P=0.006,OR=2.243,95%CI: 1.439-3.960)were independent predictors of AF early recurrence after radiofrequency ablation.ROC curve of TMAO for predicting early postoperative recurrence of AF was analyzed.The optimal threshold of serum TMAO level was 4.98umol/L,indicating a sensitivity of 72.0% and specificity of 65.5% for predicting early postoperative recurrence of AF.Conclusion: LAD and serum TMAO levels are independent predictors of early recurrence after radiofrequency ablation in patients with paroxysmal AF.Serum TMAO level has certain predictive value for early recurrence after radiofrequency ablation in patients with AF.