Résumé
Objective:To investigate the correlation between CHA 2DS 2-VASC score and the recurrence risk of paroxysmal atrial fibrillation after radiofrequency ablation. Methods:It was a retrospective cohort study. A total of 150 patients who underwent radiofrequency ablation for paroxysmal atrial fibrillation in Xingtai People′s Hospital from January 2017 to January 2021 were consecutively included in the study. According to the preoperative CHA 2DS 2-VASC score, patients were divided into high score group (≥3 points, n=90) and low score group (<3 points, n=60). Baseline clinical data was collected. All patients underwent circumferential pulmonary vein isolation, and those with atrial flutter before ablation also underwent tricuspid isthmus isolation. Holter and electrocardiogram examinations were performed at 3, 6 months and 1 year after ablation to evaluate whether there was recurrence of atrial fibrillation. Univariate and multivariate Cox regression was used to analyze the risk factors for recurrence of atrial fibrillation after radiofrequency ablation. Results:Among 150 patients 90 were males and 60 were females with a mean age of (64.0±3.6) years. There were no significant differences in age, sex, and proportion of hypertension, diabetes, chronic heart failure and stroke or transient ischemic attack (TIA), medication of antiarrhythmic and anticoagulant drugs between the two groups (all P>0.05). The longest duration of atrial fibrillation in the high score group was significantly longer than that in the low score group (26.0±6.1) hours vs. (10.0±2.1) hours, P<0.05). There were no patients with cardiac tamponade, atrial esophageal fistula and severe vascular puncture complications in the two groups. During the follow-up period, the recurrence rate in the high score group was significantly higher than that in the low score group (16.7% (15/90) vs. 8.3% (5/60), P<0.05). Multivariate Cox regression analysis showed that CHA 2DS 2-VASC score≥3 was an independent risk factor for atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation ( HR=3.84, 95% CI: 1.87-7.89, P=0.02). Conclusion:CHA 2DS 2-VASC score≥3 is an independent risk factor for atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation.
Résumé
Objective:To investigate the risk factors of atrial fibrillation (AF) in patients with typical atrial flutter after radiofrequency ablation.Methods:This study was a case-control study. The clinical data of 120 patients with typical atrial flutter who underwent radiofrequency ablation in Xingtai People′s Hospital from January 2017 to January 2021 were retrospectively analyzed. Patients were followed up every 3-6 months for a period of 2 years, and AF occurred in 30 patients (25.0%). The risk factors of AF were analyzed with univariate and multivariate logistic regressions.Results:The mean age of patients was (62.0±6.5) years and 64(53.3%) were males. No patients in the two groups had complications such as cardiac tamponade, pulmonary embolism and cerebral infarction after radiofrequency ablation. Compared with non-AF patients, patients in AF group had older age and higher CHA 2DS 2-VASC score ( P<0.001). Multivariate regression analysis showed that age ( HR=1.09, 95% CI:1.01-1.17) and CHA 2DS 2-VASC score ( HR=3.84, 95% CI:1.87-7.89) were independent risk factors for the occurrence of atrial fibrillation after radiofrequency ablation in patients with atrial flutter. Conclusion:After radiofrequency ablation of typical atrial flutter, nearly 25% of patients will relapse into AF, old age and higher CHA 2DS 2-VASC score increase the risk of AF recurrent.
Résumé
Objective:To compare the efficacy of high density grid mapping catheter (HD-Grid) and circular mapping catheter in the ablation of paroxysmal atrial fibrillation.Methods:Patients with paroxysmal atrial fibrillation undergoing radiofrequency ablation in Xingtai People′s Hospital from March 2020 to March 2021 were randomly divided into the HD-Grid group and the circular mapping catheter group. The baseline data, operation time, X-ray exposure time, pulmonary vein isolation time, recovery of pulmonary vein conduction, the number of recovery sites, and perioperative complications were compared between the two groups. The patients were followed up at 1, 3, 6 and 12 months after operation, and a continuous electrocardiogram was performed to evaluate recurrence of atrial fibrillation.Results:Sixty patients were enrolled in the study with 30 cases in each group, including 33 males and 27 females with an average age of 63.0 (57.0, 70.3) years. There were no significant differences in age, gender ratio, comorbidity proportion, CHADS 2-VASC score, history of atrial fibrillation, B-type natriuretic peptide level, and left atrial diameter between the two groups (all P>0.05). The operation time of the HD-Grid group was longer than that of the circular mapping catheter group ((136.6±7.7) minutes vs. (127.5±7.7) minutes, P<0.001). During the observation period, 8 cases (26.67%) with pulmonary venous conduction recovery were identified in the HD-Grid group, which was higher than that in the circular mapping catheter group (2 cases(6.67%)) ( P=0.038). Eighteen (60.00%) pulmonary vein reconnection sites were identified in the HD-Grid group, which were more than that in the circular mapping catheter group (2 sites(6.67%), P=0.013). There was no significant difference in X-ray exposure time and pulmonary vein isolation time between the two groups (both P>0.05). There was no significant difference in the proportion of patients taking anticoagulant drugs and antiarrhythmic drugs during the perioperative period between the two groups (both P>0.05). No serious complications such as cardiac tamponade, phrenic nerve injury, pulmonary embolism, cerebral infarction and death occurred in both groups. During the follow-up period, 1 patient (3.33%) in the HD-Grid group had recurrence of atrial fibrillation, while 5 patients (16.67%) in the circular mapping catheter group had recurrence of atrial fibrillation, but there was no significant difference between the two groups ( P=0.197). Conclusions:HD-Grid for radiofrequency ablation of paroxysmal atrial fibrillation improves the identification rate of pulmonary vein potentials and pulmonary vein reconnection sites, and it may reduce the recurrence rate of atrial fibrillation. Although the operation time was prolonged, it would not increase the risk of perioperative complications.