Risk Factors And Prediction Models For Late Recurrence Of Non-valvular Atrial Fibrillation After Catheter Ablation

Objective: Analyze the influence of monocyte count/high-density lipoprotein cholesterol(MHR),coronary heart disease(CHD),atrial fibrillation type(TYPE),atrial fibrillation course(COURSE)on the late recurrence of non-valvular atrial fibrillation after catheter ablation,construct and verify the prediction model of late recurrence of atrial fibrillation based on MHR,CHD,TYPE,COURSE,and provide individualized assessment for the risk of late recurrence of atrial fibrillation after catheter ablation of different non-valvular atrial fibrillation.Methods: A total of 184 patients with paroxysmal atrial fibrillation and persistent atrial fibrillation who underwent catheter ablation in Taizhou People’s Hospital from January 2017 to January 2019 were collected.Clinical baseline data and cardiac ultrasound of the patients were collected who meet the inclusion criteria,and the fasting venous blood routine and biochemical indicators were collected before surgery 24-hour,the operation process was detaily recorded,Patients were followed up with Holter at 3 months,6 months,12 months,18 months and 24 months after operation.according to the Holter ECG results,Patients were divided into late recurrence group and non-recurring group,Univariate and multivariate Cox regression models were used to analyze the independent risk factors for late recurrence of atrial fibrillation after catheter ablation of nonvalvular atrial fibrillation,and the nomogram method was used to construct the risk prediction of late recurrence of atrial fibrillation after catheter ablation of nonvalvular atrial fibrillation,and verify the accuracy of the model.Results:1.Univariate and multivariate Cox regression analysis results suggest that MHR,atrial fibrillation course,persistent atrial fibrillation,and atrial fibrillation combined with coronary heart disease are independent risk factors for late recurrence of atrial fibrillation after catheter ablation of non-valvular atrial fibrillation.2.The four factors of MHR,CHD,COURSE and TYPE all affect the distribution of patient recurrence time.For every unit increase in MHR,the risk of recurrence increases by12.546 times [95%CI(4.641,33.915)];For every unit increase in COURSE,The risk of recurrence increased 1.006 times [95%CI(1.002,1.009)];The risk of recurrence in patients with persistent atrial fibrillation increased by 2.263 times compared with patients with paroxysmal atrial fibrillation [95%CI1.205,4.250];Atrial fibrillation with CHD,the risk of recurrence is3.060 times higher than that of patients without CHD [95%CI1.643,5.700].3.When MHR<0.5629,the average recurrence time of atrial fibrillation is22.579[95%CI(21.738,23.419)],the average recurrence time is 13.852[95%CI(12.466,15.238)]if MHR≥0.5629;The average recurrence time was 21.917 [95%CI(20.905,22.928)] When course<17,the average recurrence time was 14.193[95%CI(12.668,15.717)] when course≥17;The recurrence time was 20.464 months [95%CI(19.359,21.570)] if without coronary heart disease,the average recurrence time of atrial fibrillation combined with coronary heart disease was 13.414[95%CI(11.546,15.281)];And the average recurrence time of paroxysmal atrial fibrillation was 20.545[95 %CI(18.829,21.019)],the average recurrence time of persistent atrial fibrillation was 13.149[95%CI(10.867,14.470)],the above differences were all statistically significant P<0.001.4.Results of nomogram model constructed based on MHR,type of atrial fibrillation,course of atrial fibrillation,atrial fibrillation combined with coronary heart disease,It is suggested that as the course of atrial fibrillation increases,the MHR increases,as well as the nomogram scores of atrial fibrillation combined with coronary heart disease and persistent atrial fibrillation,the score of the nomogram gradually increases.Among them,the MHR score is 100 points,and the atrial fibrillation course score is 70 points,The score for heart disease combined with coronary heart disease is 35 points,and the score for persistent atrial fibrillation is 28 points.The consistency index(C-index)of the nomogram model for predicting late recurrence of atrial fibrillation and actual recurrence of atrial fibrillation is 0.818(95%CL=0.681,0.954)),the consistency index(C-index)of the verification group is 0.802(95%CL=0.658,0.946),and the model calibration curve fits well with the actual curve.Conclusion:1.Preoperative MHR,atrial fibrillation with coronary heart disease,the course of atrial fibrillation,and the type of atrial fibrillation are independent risk factors for predicting late recurrence after catheter ablation of non-valvular atrial fibrillation.2.The nomogram constructed based on the four factors of MHR,atrial fibrillation combined with coronary heart disease,atrial fibrillation type,and atrial fibrillation course has a certain predictive value for the late recurrence of non-valvular atrial fibrillation after catheter ablation.