Application Value Of Right Atrial And Right Ventricular Strain In Radiofrequency Ablation In Patients With Persistent Atrial Fibrillation

Objectives:To evaluate the structure and function of the right atrium（RA）and right ventricle（RV）in patients with persistent atrial fibrillation（Ps AF）by two-dimensional speckle echocardiography,and to analyze the correlation between the function and structure of RA and RV and the recurrence of atrial fibrillation after radiofrequency ablation（RFA）in patients with Ps AF.Methods:A total of 87 patients with persistent atrial fibrillation and radiofrequency ablation were selected from the Department of structural Heart Diseases and Arrhythmias in Dalian Central Hospital from December 2021 to December 2022.After excluding 22 cases of left ventricular dysfunction,myocardial segmental movement abnormalities,hypertrophic cardiomyopathy,pacemaker implantation,apical window poor sound transmission and failure to follow up,65 patients with persistent atrial fibrillation were finally included.According to the recurrence of atrial fibrillation after radiofrequency ablation,the patients were divided into the recurrent atrial fibrillation group（n=14）and the non-recurrent atrial fibrillation group（n=51）.The general clinical data of all patients were collected,standard echocardiography was collected one day before the operation,and the strain of the right atrium and right ventricle were analyzed according to the"consensus on standardized imaging of left atrium,right ventricle,and right atrium"jointly issued by American Echocardiography Society（ASE）and European Society of Cardiovascular Imaging（EACVI）in 2018.All clinical data and ultrasonic parameters such as right ventricular structure and function were compared between the two groups,and the patients were followed up for 3-12 months.Cox proportional hazard regression model was used to analyze the clinical data and ultrasonic parameters of right ventricular structure and function related to the recurrence of atrial fibrillation,and to determine the independent predictors and risk ratio（HR）of atrial fibrillation recurrence after radiofrequency ablation.By establishing the receiver operating characteristic（ROC）curve,comparing the area under the curve（AUC）and the best truncation value of right atrial global longitudinal strain（RA GLS）and right ventricle global longitudinal strain（RV GLS）,and comparing their efficacy in evaluating the recurrence of atrial fibrillation.Results:All the patients were followed up for 3-12 months.There were 14 cases（22%）in the recurrence group and 51 cases（78%）in the non-recurrence group.There were significant differences in body mass index（BMI）and CHA₂DS₂-VASc score between the recurrent group and non-recurrent group before the operation.The maximum area of the right atrium（RAAmax）,superior and right atrial long axis diameter（RAL）,right atrial short axis diameter（RAS）,right ventricular end-systolic area（RVESA）,RAGLS,RVGLS,tricuspid annular maximal displacement at the midpoint of tricuspid annulus（Tm）,and right ventricular longitudinal shortening rate（Tm%）were significantly different between the two groups.In Cox proportional hazard analysis,RA GLS（HR=0.711,95%CI:0.511-0.989,paired 0.043）and RV GLS（HR=0.604,95%CI:0.436-0.836,p=0.002）were independent predictors of recurrence of atrial fibrillation after radiofrequency ablation.According to the subjects’working curve,the AUC of RA GLS and RV GLS in evaluating the recurrence of persistent atrial fibrillation were 0.768and 0.907 respectively.The best cutoff point of RA GLS is 7.1%,and its sensitivity and specificity for evaluating the recurrence of persistent atrial fibrillation are 85.71%and76.47%,respectively.95%confidence interval is 0.794-0.957（P<0.05）.The best cutoff value of RV GLS is 8.4%.The sensitivity and specificity for evaluating the recurrence of persistent atrial fibrillation are 92.86%and 82.35%,respectively.95%confidence interval is 0.809-0.95（P<0.05）.and the best cut-off point of RA GLS was 7.1%.The sensitivity and specificity for evaluating the recurrence of persistent atrial fibrillation were 85.71%and 76.47%,respectively（P<0.05）.The best cut-off point of RV GLS is 8.4%,and its sensitivity and specificity for evaluating the recurrence of persistent atrial fibrillation are 92.86%and 82.35%,respectively（P<0.05）.Conclusion:Evaluation of RAGLS and RVGLS in patients with persistent atrial fibrillation by two-dimensional speckle tracking technique is an effective predictor of atrial fibrillation recurrence after radiofrequency ablation.