| Objective We followed up the patients with atrial fibrillation who received radiofrequency ablation,in order to explore the value of CAAP-AF score and related clinical factors in predicting the recurrence of atrial fibrillation,to select patients with low recurrence rate and suitable for operation for radiofrequency ablation,and to provide a better treatment for patients.Methods Our study was a retrospective observational cohort study.We selected 65 patients with atrial fibrillation who received radiofrequency ablation in the first affiliated Hospital of Inner Mongolia Medical University from January 2017 to March 2019,excluding3 patients because they refused to accept follow-up examination.the subjects were 62 cases(nasty 62),of which 55 cases(88.71%)were paroxysmal atrial fibrillation.The electrocardiogram and 24-hour ambulatory electrocardiogram were followed up in the outpatient clinic at 3 months,6 months and 12 months after operation,respectively.If atrial tachycardia,atrial flutter and atrial fibrillation with a duration of more than 30 seconds were captured by 12-lead ECG or appeared in dynamic monitoring during the follow-up period,atrial fibrillation was regarded as recurrence of atrial fibrillation [6].According to the recurrence of atrial fibrillation,the patients were divided into recurrent group(n = 21)and non-recurrent group(n = 41).The preoperative sex,age,coronary heart disease,persistent atrial fibrillation,types of antiarrhythmic drugs,ejection fraction and left atrial diameter before and 1 year after operation were recorded,and the CAAP-AF score of each patient was calculated.Chi-square test or Fisher exact probability method,two independent samples and paired t-test or Wilcoxon rank-sum test,logistic test and receiver operating characteristic curve analysis were used to explore the value of CAAP-AF score and related clinical factorsin predicting recurrence of radiofrequency ablation of atrial fibrillation and the Curative effect of patients with atrial fibrillation after radiofrequency ablation.Results Results among the 62 patients,29 were female(46.77%),with an average age of(63.26 ±8.29)years,and 2(3.22%)suffered from coronary heart disease.the average preoperative left atrial diameter was 37.68 ±5.17 mm,and the average left ventricular ejection fraction was 61.82 ±8.33%.The average number of antiarrhythmic drugs that failed was 1.02±0.97.During the follow-up period,atrial fibrillation relapsed in 21 cases(33.87%).The main results were as follows:(1)the CAAP-AF score system and ejection fraction were statistically analyzed.Univariate analysis showed that persistent or long-term persistent atrial fibrillation,types of antiarrhythmic drugs,left atrial diameter and CAAP-AF score were risk factors for recurrence of atrial fibrillation after radiofrequency ablation.There was no significant difference in age,sex,coronary heart disease and ejection fraction(P >0.05),which could not be determined as the risk factors of recurrence of atrial fibrillation after radiofrequency ablation.(2)logistic regression analysis was performed on persistent or long-term persistent atrial fibrillation,types of antiarrhythmic drugs,left atrial diameter and CAAP-AF score.Multivariate analysis showed that left atrial diameter was an independent risk factor for recurrence of atrial fibrillation after radiofrequency ablation and could be used as an independent index for predicting recurrence of radiofrequency ablation of atrial fibrillation(P <0.05).(3)the recurrence rates of atrial fibrillation corresponding to each segment of left atrial diameter were as follows: 0 cases of left atrial diameter in 27?31mm(recurrence rate was 0.007%),5 cases in 32?36mm(recurrence rate was 19.23%),6 cases in37?41mm(recurrence rate was 40.00%),9 cases in 42?46mm(recurrence rate was 56.25%),and 1 case in 47?52mm(recurrence rate was 100%).No patients with left atrial diameter <27mm and >52mm were found.The receiver operating characteristic curve analysis showed that the Jordan index was 0.518 and the best critical value was 39 mm.The sensitivity,specificity,positive predictive value and negative predictive value of left atrial diameter ?39mm for predicting recurrence of atrial fibrillation were 75.60%,76.20%,86.11% and61.54%(AUC=0.748 95%CI0.617-0.879 P=0.001).The recurrence rate of atrial fibrillation was 16.27% in patients with the left atrial < 39 mm and 60.00% in patients with the left atrial? 39 mm.(4)the left atrial diameter and ejection fraction of patients with atrial fibrillation before operation and 1 year after operation were compared by paired t-test(P<0.05),and there were significant differences between patients with atrial fibrillation before operation and 1 year after operation(P <0.05).Conclusion The main results are as follows:(1)the recurrence of AF after RFCA is the result of many factors,among which persistent or long-term persistent atrial fibrillation,types of antiarrhythmic drugs,left atrial diameter and CAAP-AF score are related risk factors for atrial fibrillation recurrence after radiofrequency ablation.Age,sex,coronary heart disease and ejection fraction can not be considered as risk factors for recurrence of atrial fibrillation after radiofrequency ablation.(2)the anteroposterior diameter of left atrium can be used as an independent index to predict the recurrence of atrial fibrillation after radiofrequency ablation.(3)the larger the internal diameter of the left atrium,the higher the recurrence rate of postoperative atrial fibrillation.Preoperative evaluation of relevant indicators can help us to select patients with atrial fibrillation who are most likely to benefit from radiofrequency ablation.(4)RFCA can improve left atrial diameter and ejection fraction in patients with atrial fibrillation. |
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