Effect of catheter ablation on atrial fibrillation-mediated cardiomyopathy and its prognostic influencing factors
Objective To observe the clinical characteristics of patients with atrial fibrillation-mediated cardiomyopathy(AF-CM),the effect of catheter ablation and the influencing factors of prognosis,and to explore the indicators and diagnostic value.Methods Totally 210 patients with AF combined with heart failure(HF)underwent catheter ablation in Fuwai Central China Cardiovascular Hospital from March,2018 to February,2023,among whom 158 patients had 15％increased left ventricular ejection fraction(LVEF)or normal LVEF 6 months after catheter ablation(AF-CM group),and the other 52 patients had＜15％increased LEVF or no changed LVEF[dilated cardiomyopathy(DCM)combined with AF(DCM-AF)group].The age,gender,body mass index(BMI),duration of AF,AF type,smoking habits,acholic consumption history,and previous disease history were compared between two groups.The NYHA classification,CHA2DS2-VASc score,HAS-BLED score and low-density lipoprotein cholesterol(LDL-C)on admission,preoperative ambulatory electrocardiography results and postoperative HF medication were recorded.The levels of N-terminal pro-brain natriuretic peptide(NT-proBNP)and blood creatinine were detected before and one month after operation.Ultrasonography was performed before and 6 months after operation to record LVEF,left ventricular end-diastolic dimension(LVEDD),left atrial diameter(LAD),ventricular septal thickness and mitral regurgitation area and degree.Multivariate logistic regression was used to analyze the influencing factors of AF-CM in patients with AF combined with HF.ROC curves were plotted to assess the efficiencies of LVEDD and NYHA classification on diagnosing AF-CM.Follow-up was performed till September 1,2023,and the AF recurrence,rehospitalization due to cardiovascular events and event-free survival were compared between two groups.Results(1)The patients were older in AF-CM group[(59.260±12.442)years]than DCM-AF group[(53.980±13.220)years](t=2.613,P＜0.001).The slowest heart rate was faster in AF-CM group[(59.200±13.776)beats/min]than that in DCM-AF group[(54.810±12.720)beats/min](t=0.203,P=0.043).There were no significant differences in the CHA2DS2-VASc score,HAS-BLED score,LDL-C level,and HF medication application on admission between two groups(P＞0.05).(2)Before operation,the levels of NT-proBNP and blood creatinine were lower in AF-CM group[976.500(564.175,1 799.250)ng/L,(81.300±25.190)μmol/L]than those in DCM-AF group[1 231.000(838.275,2 093.250)ng/L,(91.710±27.186)μmol/L](P＜0.05),and the rate of NYHA class Ⅰ-Ⅱ was higher in AF-CM group(77.8％)than that in DCM-AF group(30.8％)(P＜0.05).In AF-CM group,the levels of NT-proBNP and blood creatinine were lower one month after operation[225.000(100.500,450.000)ng/L,(76.386±16.167)μmol/L]than those before operation(P＜0.05),and the rate of NYHA class Ⅰ-Ⅱ was higher one month after operation(100.0％)than that before operation(P＜0.05).In DCM-AF group,the level of NT-proBNP was lower one month after operation[679.100(392.525,1 047.250)ng/L]than that before operation(P＜0.05),the rate of NYHA class Ⅰ-Ⅱ(55.8％)was higher than that before operation(P＜0.05),and the blood creatinine level showed no significant difference(P＞0.05).One month after operation,the levels of NT-proBNP and blood creatinine were lower in AF-CM group than those in DCM-AF group,and the NYHA class Ⅰ-Ⅱ was higher in AF-CM group than that in DCM-AF group(P＜0.05).(3)Before operation,LVEDD and LAD were shorter in AF-CM group[(53.470±6.112),(43.342±6.427)mm]than those in DCM-AF group[(62.650±9.452),(45.587±6.646)mm](P＜0.05),the LVEF was larger in AF-CM group[(38.920±4.616)％]than that in DCM-AF group[(34.540±6.652)％](P＜0.05),the rate of severe mitral regurgitation was lower in AF-CM group(26.6％)than that in DCM-AF group(48.1％)(P＜0.05),and there were no significant differences in the ventricular septal thickness and mitral regurgitation area between two groups(P＞0.05).In AF-CM group,the LVEDD,LAD and mitral regurgitation area were smaller 6 months after operation[(49.820±4.624)mm,(37.910±4.568)mm,1.900(1.100,3.100)cm2]than those before operation(P＜0.05),LVEF was larger after operation[(57.580±4.351)％]than that before operation(P＜0.05),and the rate of severe mitral regurgitation was lower after operation(1.3％)than that before operation(P＜0.05).In DCM-AF group,the LVEDD and LAD were shorter after operation[(60.000±8.586),(41.940±5.903)mm]than those before operation(P＜0.05),and the LVEF was larger after operation[(40.790±6.690)％]than that before operation(P＜0.05).The LVEDD,LAD and mitral regurgitation area were smaller in AF-CM group than those in DCM-AF group 6 months after operation,the LVEF was larger and the rate of severe mitral regurgitation was lower after operation than that before operation(P＜0.05).(4)The follow-up till September 1,2023 showed no death in two groups,the rates of AF recurrence and rehospitalization due to cardiovascular events were lower in AF-CM group(8.2％,16.5％)than those in DCM-AF group(25.0％,65.4％)(P＜0.05),and the event-free survival rate was higher in AF-CM group(83.5％)than that in DCM-AF group(34.6％)(P＜0.05).(5)LVEDD(OR=0.853,95％CI:0.788-0.923,P＜0.001),and NYHA classification(OR=0.243,95％CI:0.140-0.420,P＜0.001)were the influencing factors of AF-CM in AF patients with HF.(6)When the optimal cut-off values of LVEDD and NYHA classification were 58.5 mm and 2.5,the AUCs for diagnosing AF-CM were 0.789(95％CI:0.711-0.868,P＜0.001)and 0.810(95％CI:0.745-0.875,P＜0.001),the sensitivities were 69.0％and 69.0％,and the specificities were 79.0％and 78.2％,respectively.The AUC of the combination of them two was 0.887(95％CI:0.840-0.933,P＜0.001),with a sensitivity of 74.7％and a specificity of 86.5％.Conclusions LVEDD＜58.5 mm and NYHA class ≤ Ⅱ indicate a risk of AF-CM in patients with AF combined with HF.The cardiac structure and function improve more obviously after catheter ablation in AF-CM patients than in DCM-AF patients.LVEDD in combination with NYHA clasification is of high value to the diagnosis of AF-CM.
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