Value of epicardial fat thickness combined with left atrial appendage function parameters in predicting recurrence of paroxysmal atrial fibrillation after radiofrequency ablation
Objective To explore the diagnostic value of a diagnostic model based on epicardial fat thickness(EFT)combined with left atrial appendage(LAA)functional parameters in predicting recurrence of patients with paroxysmal atrial fibrillation(AF)after radiofrequency ablation.Methods A total of 47 patients with paroxysmal AF who underwent radiofrequency ablation were enrolled,which included 22 males and 25 females,aged 41-77 years old with mean age of 62.72 years old;body mass index(BMI)was 18.0-29.6 kg/m2 with mean BMI of 25.26 kg/m2.There were 24 cases of hypertension,5 of diabetes,13 of coronary heart disease and 6 of stroke or transient ischemic attack(TIA).The low density lipoprotein(LDL)was 1.30-3.86 mmol/L with mean LDL of 2.29 mmol/L;high density lipoprotein(HDL)was 0.67-1.59 mmol/L with mean HDL of 1.07 mmol/L;serum uric acid was 123.0-514.0 µmol/L with mean of 303.70 μmol/L.The transthoracic echocardiography(TTE)and transesophageal echocardiography(TEE)were performed before operation.Follow-up began 3-month after ablation,all patients were divided into recurrence group and non-recurrence group.The predictive factors of postoperative recurrence of paroxysmal AF were ex-plored by univariate analysis and principal component analysis,and combined diagnostic model for predicting postoperative recur-rence was established.Results In univariate analysis,the age,BMI,left atrial(LA)anteroposterior diameter,EFT and maximum LAA aperture diameter of recurrent group were statistically significantly higher than those of non-recurrent group,and the differ-ences were statistically significant[7 1(61.01,73.75)years old vs 65(54.25,69.02)years old,(26.81±2.19)kg/m2 vs(24.84±2.83)kg/m2,(43.42±4.58)mm vs(40.34±4.16)mm,5.63(5.30,5.99)mm vs 4.15(3.67,5.03)mm,(21.24±3.67)mm vs(18.37±2.81)mm.P＜0.05].The LAA emptying velocity,LAA filling velocity and LAA peak strain of recurrent group were remarkably lower than those of non-recurrent group,and the difference was statistically significant[33.55(27.93,40.28)cm/s vs 43.40(33.70,77.63)cm/s,(35.06±11.02)cm/s vs(45.26±14.86)cm/s,5.85(5.18,7.08)vs 9.90(8.70,13.10).P＜0.05].The cut-off value of combined diagnostic model constructed by principal component analysis was 16.695,the area under curve for diagnosis recurrence after ra-diofrequency ablation of paroxysmal AF was 0.895,the corresponding sensitivity,specificity and accuracy were 90.0％,78.4％and 82.9％,respectively.Conclusion It is demonstrated that the EFT combined with LAA functional parameters showed certain diagnostic value in predicting the recurrence of paroxysmal AF after radiofrequency ablation.
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