| Objective: To investigate the difference about the success rate between matrix modified ablation strategy based on panoramic high-density voltage mapping and traditional circumferential pulmonary vein plus empirical linear ablation strategy in the treatment of atrial fibrillation(AF),and to explore the factors that may affect the recurrence of AF after radiofrequency(RF)ablation.Methods:A total of 244 patients with atrial fibrillation underwent RF ablation from July2019 to September 2021 in Sichuan Provincial People’s Hospital were included.Femoral vein puncture was performed under local anesthesia.After puncturing the atrial septum,the left atrial model was established by Penta Ray mapping.Low voltage area was defined as atrial voltage < 0.5mv under sinus rhythm and atrial voltage < 0.3mv under atrial fibrillation.After CPVI confirmed the electrical isolation of pulmonary veins,the experimental group underwent left and right atrial matrix improvement,and the control group underwent empirical selective linear ablation.Patients were followed up through internet connection,telephone and outpatient clinical visit,ECG and 24-hour ambulatory ECG were recorded in 1-,3-,6-12-and 24-months after AF RF procedure,or ECG was recorded immediately in case of chest tightness,palpitation and other arrhythmia-related symptoms.If the patient has recorded atrial fibrillation/atrial flutter/atrial tachycardia continuedmore than 30 seconds,or need to take antiarrhythmic drugs during follow-up beyond blanking period,it is defined as recurrence.Results:A total of 244 patients with atrial fibrillation were included,of which 18 were lost during follow-up and 2 died,so 224 patients with atrial fibrillation were finally included in the study.There were 114 cases in the experimental group,with an average follow-up time of 11.09±8.58 months,25 cases recurred(the recurrence rate was 21.9%);there were 110 cases in the control group,with an average follow-up time of 13±10.37 months,36 cases recurred(the recurrence rate was 32.7%,P=0.070).The Kaplan-Meier curve showed that there was no significant difference in recurrence rate between the two groups(log rank χ~2=1.739,P=0.187).The multivariate Cox regression results suggested that the risk of postoperative recurrence was reduced by 58.6% in the experimental group(HR,0.586[95% CI: 0.347-0.989],P=0.045).For every 1mmol / L increase in LDLc,the risk of recurrence after radiofrequency ablation of AF increased 1.557 folds(HR,1.557[95% CI: 1.074-2.258],P=0.019),the risk of recurrence after radiofrequency ablation in patients with atrial fibrillation who underwent one-stop operation left atrial appendage occlusion was reduced by 7.347 folds(HR,7.347[95% CI:1.758-30.707],P=0.006),persistent atrial fibrillation had an increased risk of recurrence after radiofrequency ablation by 2.191 folds(HR: 2.191[95% CI: 1.310-3.664],P= 0.003).In the subgroup of patients with persistent atrial fibrillation,14 cases recurred in the experimental group(recurrence rate 31.1%)and 21 cases recurred in the control group(recurrence rate 36.8%);Kaplan-Meier curve showed that there was no significant difference in recurrence between the two groups(log rank χ~2= 0.108,P=0.742);multivariate Cox analysis showed that one-stop operation of left atrial appendage occlusion was protect risk factor ofpostoperative recurrence,the risk of postoperative recurrence in patients with one-stop operation of left atrial appendage occlusion decreased by 4.574 folds(HR,4.574[95%CI:1.075-19.455],P=0.040).In the subgroup of paroxysmal atrial fibrillation,11 cases recurred in the experimental group(recurrence rate 15.9%)and 15 cases recurred in the control group(recurrence rate 25.0%);Kaplan-Meier curve showed that there was no significant difference in recurrence between the two groups(log rank χ~2= 1.265,P=0.261);multivariate Cox analysis showed that blood potassium was the risk factor of postoperative recurrence with the recurrence increased 3.335 folds for every 1mmol/l increase in blood potassium(HR,3.335[95% CI:1.169-9.512],P=0.024).Conclusion:The substrate modified ablation strategy based on panoramic high-density voltage mapping might likely better than CPVI + empirical linear ablation strategy,especially for patients with paroxysmal atrial fibrillation.The "One-stop operation" is a protective factor after radiofrequency ablation of AF,whereas persistent AF and elevated LDL were independent predictors of increased postoperative recurrence after RF ablation. |
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