| A prediction model of AF recurrenceBackground:Now,catheter ablation is an effective method to control the heart rhythm of patients with atrial fibrillation(AF),but it is inevitable to face the problem of AF recurrence.Some studies have shown that different anticoagulation strategies can be adopted for patients with recurrence and non-recurrence of AF after catheter ablation.We hope to establish a prediction model to identify those patients who are prone to recurrence.Methods:We aimed to establish a prediction model with the outcome of 2 years follow-up,the primary endpoint of this study was AF recurrence.1065 patients who underwent AF catheter ablation between January 2015 and December 2018 were consecutively included in this study,regular follow-up was performed to detect AF recurrence.Baseline data were collected before catheter ablation,Univariate analysis was tested by χ2 test and independent t-test.Variables with a P-value<0.05 in univariate analysis were entered in logistic regression.And then we draw the nomogram by using the filtered risk factors.Results:A total of 1065 patients were included in this study,and the primary endpoint was observed in 316 patients.By Univariate analysis we could find age(59.35±10.42 vs 62.15±9.36,p=0.022),BMI(26.00±3.09 vs 27.73±3.68,p=0.002),AF history(2.7±3.0 vs 3.9±3.5,p<0.001),snoring(36.2%vs 64.6%,p<0.001),hypertension(42.7%vs 50.3%,p=0.023),coronary heart disease(17.6%vs 25%,p=0.006),diabetes(11.9%vs 17.4%,p=0.016),heart failure(4.3%vs 12%,p<0.001),valve diseases(1.6%vs 4.7%,p=0.003),persistent AF(33.4%vs 50.3%,p<0.001),anteroposterior diameter of LA(39.4±5.5 vs 42.2±4.9,p=0.030)may be risk factors for AF recurrence.The above variables were treated as independent variables and AF recurrence as the dependent variable,we could further screen for risk factors by logistic regression.Ultimately,we decided to include age,BMI,AF history,snoring,heart failure,types of AF,anteroposterior diameter of LA in our prediction model according to the result of logistic regressionConclusion:We established a nomogram for predicting atrial fibrillation recurrence after first catheter ablation,and it will guide our follow-up.However,its role needs further validation.Thromboembolic risk of cessation of OAC post catheter ablation in patients with and without AF recurrenceBackground:Cessation of oral anticoagulation(OAC)is common after the first 3 months of catheter ablation of atrial fibrillation(AF);however,thromboembolic risk has not been defined in patients with and without AF recurrence(RAF vs NRAF)post ablation.Methods:We identified 796 patients who discontinued OAC at 3 months post AF ablation from January 2015 to May 2018 in our center.Regular follow-up was performed to detect RAF,collect medication management and thromboembolic and major bleeding events.Results:CHA2DS2-VASc score was 1.79±1.50;547(68.7%)patients were at intermediate and high risk(i.e.,CHA2DS2-VASc score≥1 in male patients,or≥2 in female patients);169(21.2%)were RAF.During 29.2±12.2 months follow-up,the incidence rate of thromboembolism was 1.62 per 100 patient-year(7 in 431 years)in RAF,0.33 per 100 patient-year(5 in 1,503 years)in NRAF.After adjusting for potential confounding factors,RAF was associated with more 3.5-fold higher rate of thromboembolism compared with NRAF(adjusting HR,4.488;95%CI,1.381 to 14.586).Rate of thromboembolism was even higher in patients with intermediated high risk(2.16 per 100 patient-year[7 in 323 years]vs 0.38 per 100 patient-year[4 in 1,043 years],adjusting HR,5.807;95%CI,1.631 to 20.671).In multivariate logistic regression analysis,RAF was the only independent predictor of thromboembolism(4.837[1.498 to 15.621],p = 0.008).Conclusion:In conclusion,cessation of OAC in NRAF may be reasonable,especially for patients with the contraindications for continuing OAC;however,cessation of OAC appeared unsafe in RAF with a high-risk stroke profile because of high incidence rate of thromboembolism. |
PDF Full Text Request