Effect Of Atrial Wall Thickness Assessed By CMR On Recurrence Of Patients With Paroxysmal Atrial Fibrillation After Circumferential Pulmonary Vein Isolation

Objective:To explore the influence of the thickness of the posterior wall of left atrium measured by cardiac magnetic resonance on the recurrence of patients with paroxysmal atrial fibrillation after circumferential pulm-onary vein isolation.Methods:Select 157 patients with paroxysmal atrial fibrillation who underwent CPVI for the first time in the Department of Cardiovascular Medicine of our hospital from January 2019 to December 2021.Follow-up was carried out from 3 months to 12 months after the operation,and the patients were finally divided into recurrent atrial fibrillation group and non-recurrent atrial fibrillation group.Collect general clinical data of patients:age,gender,course of atrial fibrillation,smoking and drinking history,complications(including hypertension history,diabetes history,coronary heart disease history,heart failure history,cerebrovascular accident history,chronic obstructive pulmonary disease history);Preoperative blood parameters:fasting blood glucose,serum potassium,uric acid,low density lipoprotein cholesterol,high density lipoprotein cholesterol,triglyceride,total cholesterol,serum creatinine,homocysteine,B-type natriuretic peptide,and blood platelet;Preoperative echocardiographic indexes:left atrial anteroposterior diameter(LAD),left ventricular ejection fraction(LVEF);Left atrial wall thickness measured by CMR:the thickness of segment A and segment B.The statistical data were first analyzed by single factor analysis,and then the statistically significant variables in the single factor analysis(P<0.05)were included in the multivariate logistic regression to explore the independent influencing factors of the recurrence of patients with paroxysmal atrial fibrillation after CPVI.The best cutoff value and various influencing factors were analyzed by using the receiver operating characteristic(ROC)curve.Results:A total of 157 subjects were collected in this study,including 31 recurrent patients and 126 non recurrent patients.Single factor analysis of statistical data found:LAD in patients with recurrent atrial fibrillation was higher than that in patients without recurrent atrial fibrillation(42.39±3.55 VS 38.32±4.43,P<0.001).The thickness of segment A in recurrent atrial fibrillation group was higher than that in non recurrent atrial fibrillation group(15.10±3.59 VS 12.49±3.58,P<0.001),and the thickness of segment B in recurrent atrial fibrillation group was higher than that in non recurrent atrial fibrillation group(17.77±2.40 VS 16.01±2.22,P<0.001).Multi factor logistic regression analysis found that:The thickness of segment A(P=0.040,OR=1.278,95%CI:1.011-1.616)and LAD(P<0.001,OR=1.229,95%CI:1.098-1.376)were independent factors influencing the recurrence of paroxysmal atrial fibrillation patients after CPVI.ROC curve analysis shows that the thickness of segment B and LAD have certain predictive efficacy for the recurrence of CPVI in patients with paroxysmal atrial fibrillation.The area under the curve of the thickness of segment B is 0.700,the optimal cutoff value is 16.55,the sensitivity is 74.2%,the specificity is 68.3%,the area under the curve of LAD is 0.763,the optimal cutoff value is 39.5,the sensitivity is 77.4%,and the specificity is 65.1%.Conclusions:1.Patients with paroxysmal atrial fibrillation were followed up for 12 months after the first CPVI,and the recurrence rate was 19.75%.2.The thickness of B segment assessed and LAD assessed before operationare are independent factors influencing the recurrence of patients with paroxysmal atrial fibrillation after CPVI.The study suggests that the thickness of segment B≥16.55 dmm can be used as a high-risk predictor of CPVI recurrence in patients with paroxysmal atrial fibrillation(sensitivity:74.2%,specificity:68.3%);LAD≥39.5mm can be used as a high-risk predictor of recurrence in patients with paroxysmal atrial fibrillation after CPVI(sensitivity:77.4%,specificity:65.1%).