Forecasting of recurrent atrial fibrillation after radiofrequency ablation of pulmonary veins using preoperative characteristics

Background. Atrial fibrillation (AF) is the most frequent arrhythmia. The method of catheter radiofrequency ablation (CRA) of pulmonary veins (PV) does not guarantee the preservation of sinus rhythm. Determination of predictors of AF relapses dictates the need in systemic approach taking into account demographic and clinical-instrumental characteristics of patients. Objective. Determination of preoperative predictors of AF recurrence within 3 year after follow-up CRA PV.Design and methods. The study included 89 patients (50 men, 39 women; mean age 58 and 62 years respectively) followed during 3 years after CRA PV. The methods of principal components and discriminant analysis were used for analytical purposes. Results. The recurrence of AF was observed in 43 patients (48 %): during the first year — in 18 (43 %), during the second — in 16 (37 %), during the third — in 9 (20 %) cases. By consistently using the methods of descriptive and multivariant statistics a set of the preoperative indicators has been identified that distinguishes patients with AF relapses undergone CRA PV. It consists of the longivity of AF, the state of contractive myocardial function, the presence of ICD, cardioversion in the past and thyroid pathology. The contribution of modified risk factors: SBP level, BMI, tobacco smoking also are valued. Conclusion. Using of multivariant statistics allows to determine preoperative characteristics, which provide optimization of management of patients with AF.

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The preablation monocyte/ high density lipoprotein ratio predicts the late recurrence of paroxysmal atrial fibrillation after radiofrequency ablation

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01670-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

She-an Chen ◽

Man-man Zhang ◽

Meifang Zheng ◽

Fei Liu ◽

Lei Sun ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

High Density Lipoprotein ◽

Predictive Value ◽

Density Lipoprotein ◽

Late Recurrence ◽

High Density ◽

Significant Difference ◽

Af Recurrence

Abstract Background The monocyte/high-density lipoprotein ratio (MHR) has emerged as a promising alternative biomarker in the fields of cardiovascular disease and atrial fibrillation (AF). This retrospective study was aimed to explore the predictive value of the MHR for the late recurrence of AF after radiofrequency ablation. Methods From April 2015 to October 2018, patients with paroxysmal AF who had undergone radiofrequency catheter ablation at Subei People’s Hospital of Jiangsu Province were enrolled in our study. All the participants were observed until November 2019 after the procedure. During the postoperative follow up, the patients were categorized into the recurrence group and maintenance of sinus rhythm group based on who had experienced AF recurrence. Results One hundred twenty-five patients were diagnosed with paroxysmal AF, with an average age of 61.2 ± 9.3 years. Forty-seven patients had developed late recurrence during a mean follow up of 25.1 ± 12.0 months. The AF recurrence event rates were significantly increased in the highest MHR tertile compared with those in the lowest MHR tertile (22.0% vs. 57.1%; P < 0.05). On multivariate logistic regression analysis, the preablation MHR (OR = 1.34; 95% CI = 1.12 ~ 1.60; P = 0.001) and left atrial diameter (LAD) (OR = 1.21, 95% CI = 1.08 ~ 1.35; P = 0.001) were independent risk factors predicting the recurrence of AF after radiofrequency ablation. Furthermore, receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the MHR was 0.712 (95% CI = 0.618 ~ 0.806; P = 0.000) and that of LAD was 0.739 (95% CI = 0.653 ~ 0.814; P = 0.000). Z-test found no significant difference between the MHR and LAD regarding the AUC (Z = 0.451; P = 0.652). Conclusion An elevated preablation MHR was associated with an increased risk of the postoperative recurrence of AF. Additionally, the MHR independently predicted the late recurrence of paroxysmal AF after radiofrequency ablation, with the same predictive value as LAD.

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The Association of Left Atrial Appendage Morphology to Atrial Fibrillation Recurrence After Radiofrequency Ablation

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.677885 ◽

2021 ◽

Vol 8 ◽

Author(s):

Shiyu Gong ◽

Jian Zhou ◽

Bingyu Li ◽

Sheng Kang ◽

Xiaoye Ma ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Recurrence Rate ◽

Morphological Feature ◽

Left Atrial ◽

Left Atrial Appendage ◽

Recurrence Risk ◽

Atrial Appendage ◽

Af Recurrence

Objective: The probability of late recurrent atrial fibrillation (AF) after radiofrequency ablation (RFA) has not yet been fully clarified. This study aims to study the association of left atrial appendage (LAA) morphology with AF recurrence after RFA.Methods: We retrospectively enrolled 84 patients (24 patients had persistent AF, 60 patients had paroxysmal AF) who underwent RFA in Shanghai East Hospital from June 2014 to May 2018. The mean follow-up of these patients was 618.6 days. According to preoperative transesophageal echocardiography (TEE), the morphology feature of LAA was classified and evaluated by two classification methods. The first method was divided into chicken-wing, windsock, cactus, and cauliflower, and the second method was divided into one lobe, two lobes, and multiple lobes. The correlation between morphological feature of LAA and the recurrence rate of AF after RFA was analyzed.Results: During follow-up, 12 patients (50%) and 10 patients (16.7%) had AF recurrence in persistent and paroxysmal AF, respectively. The LAA morphology was associated with the recurrence of AF after RFA with the chicken-wing highest recurrence risk (68.2%). The structure type of LAA was also related to the AF recurrence rate (p < 0.01). Compared with one lobe and multiple lobes, two lobes (recurrence, 47.6%) were more likely associated with the recurrence of AF (p < 0.02). Logistic regression analysis showed that the chicken-wing group had a higher risk of recurrence after RFA (OR = 8.13, p = 0.004), and the windsock group had a lower risk of recurrence (OR = 0.17, p = 0.002).Conclusion: The morphological feature of LAA is related to the recurrence risk of AF after RFA. LAA morphology assessment can predict the risk of AF recurrence.

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Pulmonary Vein Activity Organization to Determine Atrial Fibrillation Recurrence: Preliminary Data from a Pilot Study

Mathematics ◽

10.3390/math8101813 ◽

2020 ◽

Vol 8 (10) ◽

pp. 1813

Author(s):

Raquel Cervigón ◽

Javier Moreno ◽

José Millet ◽

Julián Pérez-Villacastín ◽

Francisco Castells

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Cross Correlation ◽

Spatial Organization ◽

Pulmonary Veins ◽

Transfer Entropy ◽

First Year ◽

Atrial Fibrillation Recurrence ◽

Ablation Procedure ◽

Af Recurrence

Ablation of pulmonary veins has emerged as a key procedure for normal rhythm restoration in atrial fibrillation patients. However, up to half of ablated Atrial fibrillation (AF) patients suffer recurrences during the first year. In this article, simultaneous intra-atrial recordings registered at pulmonary veins previous to the ablation procedure were analyzed. Spatial cross-correlation and transfer entropy were computed in order to estimate spatial organization. Results showed that, in patients with arrhythmia recurrence, pulmonary vein electrical activity was less correlated than in patients that maintained sinus rhythm. Moreover, correlation function between dipoles showed higher delays in patients with AF recurrence. Results with transfer entropy were consistent with spatial cross-correlation measurements. These results show that arrhythmia drivers located at the pulmonary veins are associated with a higher organization of the electrical activations after the ablation of these sites.

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Safety and outcome of cryoballoon ablation versus radiofrequency catheter ablation of the pulmonary veins in patients with paroxysmal atrial fibrillation

QJM ◽

10.1093/qjmed/hcaa041.027 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

O H M A Riad ◽

T Wong ◽

A N Ali ◽

M T Ibrahim ◽

M A Abdelhamid ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Catheter Ablation ◽

Pulmonary Vein ◽

Paroxysmal Atrial Fibrillation ◽

Pulmonary Veins ◽

Cryoballoon Ablation ◽

The Mean

Abstract Background Pulmonary vein isolation (PVI) has become the mainstay of catheter ablation of atrial fibrillation (AF). There are two commonly used methods to isolate the pulmonary veins, either point-by-point delivery of circumferential lesion sets around ipsilateral pulmonary veins using radiofrequency energy, or the application of the cryoballoon to the pulmonary vein antrum with occlusion of the vein ostium. The cryoballoon has proven to be a reliable alternative to radiofrequency ablation in acute and long-term freedom from AF. We describe our results using both modalities. Aim and Objectives to compare the safety and efficacy of cryoballoon (CB) ablation and radiofrequency (RF) ablation in treatment of paroxysmal atrial fibrillation. Patients and Methods Forty-four consecutive patients having paroxysmal AF underwent PVI using the second generation cryoballoon were compared to a retrospective cohort of 69 patients who had radiofrequency induced PVI, either by conventional RF catheter (n = 32), or a contact-force sensing-catheter (n = 37). The study took place at Ain Shams university hospitals and Royal Brompton & Harefield NHS trust. Patient data, procedural data and follow up data- at 3, 6 and 12 months- were collected and analysed. Recurrence was defined as documented AF or atrial arrhythmias with duration exceeding 30 seconds, either by 12 lead ECG or an ambulatory monitoring device. Results A total of 113 patients were studied. The mean age was 53.84 ± 15.01 for the CB group and 55.78 ± 14.84 for the RF group and females representing 40.9% vs 34.8% respectively. The mean procedural times in minutes were significantly less in the CB group (94.37 ± 39.32 vs 184.57 ± 88.19, p < 0.0001), while the median fluoroscopy times were similar [30 (11.04 - 40) vs 37.25 (14.2 - 70), p = 0.172]. Procedural complications were comparable between the two groups (p = 0.06) with 1 patient (2.3%) having long term phrenic nerve paresis. At 1 year follow up, after an initial 90-day blanking period, recurrence rate of CB was similar to RF (27.3% vs 30.4% respectively, p = 0.719), the Kaplan Meier estimates of AF- free survival for a period of 1 year were comparable between both groups (log rank test, p = 0.606). Conclusion Cryoballoon is a feasible method for pulmonary vein isolation with similar success rates to radiofrequency ablation. Cryoballoon ablation is safe with shorter duration of the procedure.

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Diagnostic utility of long-term remote ECG monitoring in compare with 24 hour Holter monitoring in patients with atrial fibrillation after catheter radiofrequency ablation in the early postoperative period

Terapevticheskii arkhiv ◽

10.26442/00403660.2018.12.000002 ◽

2018 ◽

Vol 90 (12) ◽

pp. 12-16

Author(s):

G V Ryabykina ◽

Z O Shokhzodaeva ◽

O V Sapelnikov ◽

M I Makeev ◽

E Sh Kozhemyakina ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Remote Monitoring ◽

Pulmonary Veins ◽

Holter Monitoring ◽

Early Postoperative Period ◽

Diagnostic Utility ◽

Ecg Monitoring ◽

Af Recurrence

Aim. To evaluate the diagnostic utility of long-term remote monitoring of ECG compared with 24 hour Holter monitoring for the detection of cardiac arrhythmias and conduction disturbance in patients with atrial fibrillation (AF) after catheter radiofrequency ablation (RFA; isolation) of the pulmonary veins. Materials and methods. The study included 62 patients aged 58.5±11.1 years, with paroxysmal or persistent AF, after catheter RFA (pulmonary veins isolation). Patients underwent long-term remote ECG monitoring, 24 hour Holter monitoring and transthoracic echocardiogram. Results and discussion. After 24 hour Holter monitoring of 62 patients with AF after RFA in 21 of them (33.9%) was detected early recurrence of AF. Remote ECG monitoring of 18 patients, detected AF in 7 patients (39%), 2 of them were asymptomatic AF recurrence. 24 hour Holter monitoring of the same 18 patients AF recurrence was not detected at all (0%). Conclusion. Both of devices, long-term remote monitoring of ECG and 24 hour Holter monitoring detected 45.2% of recurrence of AF. Over the wearing of both devises 24 hour Holter and long-term remote monitor the last detected more events among 18 patients (33% vs 0%). Two evens of AF recurrence were asymptomatic.

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Abstract 2544: Pulmonary Venous Anatomy Predicts Recurrent Arrhythmia after Pulmonary Vein Antrum Isolation for Atrial Fibrillation

Circulation ◽

10.1161/circ.116.suppl_16.ii_562-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Ron Jacob ◽

Dimpi Patel ◽

Michael Lieber ◽

Michelle Williams ◽

Andrea Natale ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Veins ◽

Complex Anatomy ◽

Recurrent Atrial Fibrillation ◽

Increased Risk ◽

Left Pulmonary Vein ◽

Pulmonary Vein Anatomy ◽

Pulmonary Vein Antrum Isolation

Background: Pulmonary Vein Antrum Isolation (PVAI) is being used with increasing frequency for the treatment of atrial fibrillation. Multi-detector computed tomography (MDCT) can be used to evaluate the complex anatomy of the left atrium and pulmonary veins to facilitate PVAI. We hypothesized that pulmonary vein anatomy, as determined by MDCT, would predict recurrent atrial fibrillation after PVAI. Methods: We evaluated consecutive patients scheduled for PVAI who underwent a CT examination of the pulmonary veins on a Philips Brilliance 64 or Siemens Sensation-64 slice MDCT scanner < 3 months prior to a PVAI procedure. The number and ostial area of all pulmonary veins, indexed to body surface area, were determined by 2 independent blinded observers. Transtelephonic monitoring was performed for the first 3– 6 months after the PVAI procedure. Patients were followed at 3, 6, and 12 months with a 12-lead EKG and 48-hour Holter monitor. Results: A total of 113 patients (mean age 58±10 years; 73% male) were enrolled and followed for 12 months. A total of 445 pulmonary vein ostia were analyzed; 26% of patients had left sided pulmonary veins with a shared common ostium. The remaining patients had 2 separate left sided pulmonary veins. At the end of the 12-month follow-up, patients with two left sided pulmonary veins had a significantly increased risk of recurrent arrhythmia (34.3%) after PVAI than patients with a common left pulmonary vein (7.7%; p=0.009; OR 4.45). There was no relationship between the number of right sided pulmonary veins or total pulmonary vein ostial size and recurrent arrhythmia (582 cm 2 /m 2 in patients with recurrence vs 505 cm 2 /m 2 without recurrence (P= 0.14). Conclusion: In patients undergoing PVAI for atrial fibrillation, the presence of two left sided pulmonary veins, as determined by MDCT, is associated with an increased risk of recurrent arrhythmia at 12 months compared with patients who have a single common left pulmonary vein.

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Recurrence of atrial fibrillation after successful radiofrequency catheter ablation of accessory pathway in patients with Wolff-Parkinson-White syndrome

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1004170m ◽

2010 ◽

Vol 138 (3-4) ◽

pp. 170-176

Author(s):

Nebojsa Mujovic ◽

Miodrag Grujic ◽

Stevan Mrdja ◽

Aleksandar Kocijancic ◽

Bosiljka Vujisic-Tesic ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Catheter Ablation ◽

Accessory Pathway ◽

Structural Heart Disease ◽

Older Age ◽

First Year ◽

Symptomatic Recurrence ◽

Af Recurrence

Introduction. Paroxysmal atrial fibrillation (AF) occurs in 11.5-39% of the patients with Wolff-Parkinson-White (WPW) syndrome and frequently, but not always, disappears after successful accessory pathway (AP) ablation. Objective. To determine AF recurrence rate, time to AF recurrence and predictors of AF recurrence after radiofrequency (RF) catheter-ablation of AP in WPW-patients with AF. Methods. Data from 245 consecutive patients with WPW-syndrome who underwent RF catheter-ablation of AP were analyzed. A total of 52 patients (43 men, mean age: 42.5?14.1 years) with preablation history of spontaneous AF were followed up after definitive AP ablation. At baseline, structural heart disease and comorbidities were diagnosed in 19.2% and 21.2% of the patients, respectively. Results. During the follow-up of 5.2?3.7 years, 3 patients (5.7%) died; one of these patients, previously known for recurrent AF, died from ischaemic stroke. Symptomatic recurrence of AF was detected in 9 of 52 patients (17.3%). In 66.7% of these patients, AF recurrence was identified in the first year following the procedure. Kaplan-Meier analysis demonstrated that freedom from recurrent AF after 3 months was 94.2%, after 1 year 87.5% and after 4 years 84.3%. Univariate analysis showed that older age (p=0.023), presence of structural heart disease (p=0.05) and dilated left atrium (p=0.013) were significantly related to AF recurrence. However, using multivariate Cox regression, older age was the only independent predictor of AF recurrence (HR=2.44 for every life decade; p=0.006). Analysis of ROC curves showed that, after the age of 36, the risk of AF recurrence abruptly increased. Conclusion. Symptomatic recurrence of AF was detected in 17% of WPW-patients after definite RF ablation of AP. The timedependent occurrence of AF recurrences and age-dependent increase in the rate of AF recurrence were identified. Closer follow-up and/or extension of drug therapy in older patients, at least in the first year after the procedure, seem prudent.

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Six-months success of radiofrequency ablation in cardiac arrhythmias treatment: Experience of our centre

Vojnosanitetski pregled ◽

10.2298/vsp170125109j ◽

2019 ◽

Vol 76 (4) ◽

pp. 398-403

Author(s):

Ruzica Jurcevic-Mudric ◽

Lazar Angelkov ◽

Milosav Tomovic ◽

Dejan Kojic ◽

Predrag Milojevic

Keyword(s):

Atrial Fibrillation ◽

Ventricular Tachycardia ◽

Radiofrequency Ablation ◽

Atrial Flutter ◽

Cardiac Arrhythmias ◽

Paroxysmal Atrial Fibrillation ◽

Atrial Tachycardia ◽

Pulmonary Veins ◽

Av Node

Background/Aim. Numerous trials have shown a high success of radiofrequency ablation (RFA) in the treatment of the patients with cardiac arrhythmias. We aimed to examine the RFA initial success in treatment of different cardiac arrhythmias and the RFA success after 6 months of followup. Second aim was to evaluate influence of all clinical and echocardiography parameters on initial and 6-month success and failure of RFA. Methods. The present study included 320 consecutive patients with atrial and ventricular arrhythmias in which RFA was performed during 2014 in the Institute for Cardiovascular Diseases ?Dedinje?, Belgrade, Serbia. We evaluated the initial RFA success and success of this procedure after 6-month follow-up. We also investigated the prognostic role of clinical and echocardiography parameters on initial and 6-month success and failure of RFA. Results. The RFA initial success for RFA of atrioventriculas (AV) node and AV nodal reentrant tachycardia (AVNRT) was 100%, RFA of pulmonary veins 99%, RFA of atrial flutter 92%, RFA of premature ventricular complexes (PVC) and the Wolf-Parkinson-White (WPW) syndrome 87%, RFA of ventricular tachycardia 85% and RFA of atrial tachycardia 78%. The success of RFA after 6 months of follow-up for RFA of the AV node was 100%, RFA of AVNRT 94%, RFA of atrial flutter 90%, RFA of WPW syndrome 86%, RFA of pulmonary veins 79% (paroxysmal atrial fibrillation 88% and persistent atrial fibrillation 63% with a significant difference p < 0.05), RFA of PVC 78%, RFA of ventricular tachycardia 77% and RFA of atrial tachycardia 67%. Conclusion. This study proved a very high RFA initial success in treatment of cardiac arrhythmias and a satisfactory RFA success after 6 months of follow-up. Only the prognostic value had the type of atrial fibrillation in the group with catheter ablated pulmonary veins: after 6-month follow-up, the patients with paroxysmal atrial fibrillation had a significantly better outcome than those with persistent form.

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390 Late pleuro-pericardial effusion after atrial fibrillation radiofrequency ablation

European Heart Journal Supplements ◽

10.1093/eurheartj/suab142.046 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Luisa Airoldi ◽

Lidia Rossi ◽

Ailia Giubertoni ◽

Sara Bacchini ◽

Alice Panizza ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Pleural Effusion ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Myocardial Infarct ◽

Pulmonary Veins ◽

Clinical Manifestations ◽

Pericardial Fluid ◽

Recurrent Atrial Fibrillation

Abstract Aims Post-cardiac injury syndrome (PCIS) is an inflammatory state involving pericardium, epicardium, and myocardium causing a clinical picture in which epicardial and pericardial symptoms are prevalent. It appears mediated by autoimmune mechanisms and may appear as late post myocardial infarction pericarditis (Dressler’s Syndrome) or as a post traumatic pericarditis in the case of spontaneous thoracic trauma or iatrogenic pericarditis. Apart from the acute setting, pericardial effusion can be a manifestation of PCIS after interventional procedures. Methods and results A 57 years old hypertensive woman suffering from recurrent atrial fibrillation episodes underwent a technically difficult radio-frequency catheter ablation because of complex pulmonary veins anatomy and wide scar in the left atrial wall. During the procedure she developed cardiac tamponade and 410 ml of blood were drained by pericardiocentesis and re-infused without recurrent pericardial effusion during further in-hospital stay. She was discharged on apixaban 5 mg b.i.d. with Hb value of 10.2 g/dl. Two weeks later the patient was hospitalized for worsening cough, atypical chest pain, dyspnoea and modest orthopnea. C-reactive protein levels were 8.7 mg/dl, Hb was 9.9 g/dl and platelet count 484 000/ml; blood cultures were negative. An urgent thoracic CT scan showed bilateral pleural effusion and ubiquitous pericardial effusion (2.5–3 cm), without signs of active bleeding from the cardiac chambers into the pericardium. After stopping apixaban, the patient was given colchicine (1 mg/die). A total of 1200 ml of hematic pericardial fluid was drained from the pericardium over a 5-day period. Autoimmune blood tests were negative, as well as antibodies to pericardiotropic viruses. Pericardial fluid was negative for quantiferon and direct BK. On day 9, the drain was removed and steroidal treatment was started (prednisone 25 mg/die with scheduled tapering). Further echocardiographic exams were stable without pericardial effusion; a chest X-ray scan (at day 16) showed reversal of the water bottle shaped heart and of the pleural effusion. Conclusions Early myocardial infarct-associated pericarditis and Dressler’s syndrome account for about 20% of cases of PCIS accompanied by symptoms of epicardial and pericardial origin. PCIS is quite common after cardiac surgery, but it may be also observed even after iatrogenic trauma occurring during cardiac interventions: PCI, pacemaker lead insertion, radiofrequency ablation and Swan–Ganz catheterization. Blood entering the pericardium is thought to play a pivotal etiological role in iatrogenic PCIS, with consequent huge inflammatory reaction in the mesothelial tissue resulting in clinical manifestations of pericarditis. In animal models of PCIS, systemic release of cardiac antigens and self-antigen specific responses has been hypothesized. In our case cardiac tamponade complicating the ablation procedure probably initiated the epicardial and pericardial inflammatory response. Even if based on few data, the patient was treated with colchicine first, avoiding aspirin because of the hemorrhagic pericardial fluid; glucocorticoids were then started when symptoms and signs of PCIS slowly resolved despite colchicine treatment. The pericardial fluid was hemorrhagic (Hb 5.9 g/dl) and treatment with apixaban, in the context of an inflammatory mesothelial response, could have caused this peculiar, hemorrhagic, pericardial reaction.

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A novel predictive model of recurrence after surgical ablation of valvular atrial fibrillation

10.22541/au.162529049.97523344/v1 ◽

2021 ◽

Author(s):

Yali Wang ◽

Xinlong Tang ◽

Adili Ailiya ◽

Can Xu ◽

Xiyu Zhu ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Predictive Model ◽

Early Recurrence ◽

Function Parameter ◽

Valvular Surgery ◽

Risk Predictors ◽

Af Recurrence

Background: Radiofrequency ablation(RFA) has emerged as a common approach to treatment of atrial fibrillation(AF) coupled with valve surgery. However, risk factors were rarely reported on recurrence after RFA of valvular atrial fibrillation . Methods: Retrospective study of a single-center database was performed in patients underwent valvular surgery combined with radiofrequency ablation. Follow-up was conducted from 3 months to 1 year after procedure. AF recurrence was defined as any episode of atrial arrhythmia lasting more than 30 seconds. Risk factors were analysis using Logistic regression and a predictive model was established. Results: 3-month follow-up was completed in 319 patients, 195 patients (61.1%) had AF recurrence. During the 1-year follow-up, 74 /166 patients(44.6%) had AF recurrence. Compared with sinus rhythm maintenance group, overweight(p=0.022), high BMI(p=0.024), large preoperative LAD(p<0.001), small MI area(p=0.019), large MI diameter(p<0.001) and other liver function parameter like low ALT level(p=0.023), high total bilirubin(p=0.013) and direct bilirubin level(p=0.033) were significantly correlated with AF recurrence after RF. In multivariate analysis, BMI(OR 1.12, 95% CI 1.04-1.21, p=0.003), LAD(OR 1.49, 95% CI 1.09-2.07, p=0.015), MI area(OR 0.41, 95% CI 0.18-0.85, p=0.023), MI diameter(OR 2.45, 95% CI 1.16-5.34, p=0.021), ALT(OR 0.98, 95% CI 0.97-0.99, p=0.002) and eGFR(OR 1.01, 95% CI 1.09-1.02, p=0.042) were significantly independent risk predictors of AF early recurrence. A predictive model was created with AUC of 0.720. Conclusions: BMI、LAD、MI area、MI diameter、ALT and eGFR were risk predictors of AF early recurrence. We established a predictive model and it devote to preoperative clinical health management of individual with valvular AF.

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