Relationship Of Preoperative Th-17 And IL-17 With Recurrence After Radiofrequency Ablation For Atrial Fibrillation

Objective:To speculate the preoperative expression levels of Th17 and IL-17 in peripheral blood of patients undergoing radiofrequency ablation for atrial fibrillation(AF),and explore their relationship with recurrence.Methods:This study retrospectively analyzed 89 patients who underwent radiofrequency ablation for AF in Luoyang Central Hospital for the first time between July 2018 and March 2019.A total of 84 patients were enrolled,including 45 males and 39 females aged 31～86 years old,with an average of(61.1±12.3)years old.Among them,there were 41 patients with persistent AF and 43 patients with paroxysmal AF.Patients with persistent AF were divided into the non-recurrence group(CA)and the recurrence group(CB).Patients with paroxysmal AF were also divided into the non-recurrence group(ZA)and the recurrence group(ZB).The venous blood of all patients was collected within 24 hours after admission to detect Th-17,IL-17,myocardial enzymes,thyroid function,coagulation function,liver and kidney function.Warfarin was discontinued at 3 days before radiofrequency ablation,and low molecular weight heparin was injected subcutaneously till the day before surgery.The patient underwent radiofrequency ablation under sedation,fasting and general anesthesia.12 lead ECG monitoring was performed within 24 hours after surgery to determine whether the sinus rhythm of the patient recovered.All patients orally took warfarin for 3 months after radiofrequency ablation.The international normalized ratio(INR)was monitored,and the ratio was maintained between 2.0 and 3.0.The patients took antiarrhythmic drug amiodarone 0.2g/times,once/d,and the ablation effect was observed after 3 months of medication.The patients were followed up at 1 month,3 months,6 months and 12 months after surgery,and the recurrence of AF was monitored.The baseline data,preoperative peripheral blood Th17 and IL-17 levels of different groups were compared.SPSS 20.0 software was used for statistical analysis.Pearson analysis was performed to analyze the correlation between Th-17 and IL-17 levels,and receiver operator characteristic curve(ROC)was used to evaluate the value of serum Th-17 and IL-17 levels in predicting recurrence of AF after radiofrequency ablation.Results:(1)Of the 84 patients enrolled,41 had persistent AF and 43 had paroxysmal AF.There were 28 males and 13 females with persistent AF,including 28 cases without recurrence and 13 cases with recurrence,aged 60.1±10.4 years old.30 males and 13 females had paroxysmal AF,including 38 cases without recurrence and 5 cases with recurrence,aged 62.1 ±11.7 years old.Single factor analysis of baseline data of CA group and CB group,ZA group and ZB group showed that the left atrial anteroposterior diameter and left atrial diameter of CA group[(37.6±6.8)mm,(2.14±0.38)cm/m2]were significantly smaller than those of CB group[(43.9±9.2)mm,(2.51±0.60)cm/m2].Those of ZA group[(36.9±7.2)mm,(2.07±0.43)cm/m2]were significantly lower than those of ZB group[(44.3±7.6)mm,(2.54±0.61)cm/m2](P<0.05).(2)Levels of preoperative peripheral blood Th17 and IL-17 were lower in CA group[(1.48±0.18)%,(11.85±2.59)pg/ml]than CB group[(1.84±0.35)%,(14.03±2.04)pg/ml],and lower in ZA group[(1.40±0.40)%,(9.81±3.09)pg/ml]than ZB group[(1.88±0.32)%,(13.54±4.63)pg/ml](P<0.05).(3)Preoperative peripheral blood Th17 and IL-17 levels were positively correlated in patients with persistent AF(r=0.470,P<0.05)and patients with paroxysmal AF(r=0.444,P<0.05).(4)Multivariate regression analysis of risk factors for recurrence of AF showed that the type of AF was an independent risk factor for postoperative recurrence of AF(OR=3.425,95%CI=2.221～5.281,P<0.001).Th17 and IL-17 in both patients with persistent AF(Th17:OR=1.064,95%CI=1.009～1.122,P=0.022;IL-17:OR=1.050,95%CI=1.014～1.088,P=0.007)and patients with paroxysmal AF(Th17:OR=1.101,95%CI=1.032～1.174,P=0.004;IL-17:OR=1.078,95%CI=1.014～1.145,P=0.016)were independent risk factors for postoperative recurrence of AF.(5)Both Th-17 and IL-17 are of great value for predicting recurrence of persistent AF.When the Th-17 level was 1.83%,the sensitivity and specificity were 0.577 and 0.966.when the IL-17 level was 9.98 pg/ml,the sensitivity and specificity were 0.782 and 0.624.Both Th-17 and IL-17 are of great value for predicting recurrence of paroxysmal AF.When the Th-17 level was 1.67%,the sensitivity and specificity were 0.800 and 0.756.When the IL-17 level was 10.66 pg/ml,the sensitivity and specificity were 0.850 and 0.604.Conclusion:(1)The peripheral blood Th17 level is positively correlated with IL-17 level in patients with AF before surgery.(2)The Th17 and IL-17 levels are significantly higher in patients with recurrent AF than those without.(3)Th17 and IL-17 are independent risk factors for recurrence of both persistent and paroxysmal AF.