Influencing factors of TCM and western medicine and prediction model construction for late recurrence of atrial fi-brillation after first radiofrequency catheter ablation
Objective To investigate the independent influencing factors of TCM and Western medicine of late re-currence after the first radiofrequency catheter ablation(RFCA)in patients with atrial fibrillation(AF),and construct a clinical prediction model.Methods Three hundred and fourty-two patients with AF who underwent RFCA for the first time in the Cardiovascular Department of Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from Jan-uary 2018 to December 2022 were retrospectively selected as the study subjects.According to the occurrence of late recur-rence,the included cases were divided into recurrence group(n=105)and non-recurrence group(n=237).Multivariate lo-gistic regression analysis was used to analyze the influencing factors of late recurrence after the first RFCA in AF;A nomo-gram model was constructed to predict the late recurrence after the first RFCA in AF.The predictive effectiveness of the no-mogram model was assessed by receiver operating characteristic(ROC)curve.The fit ability and calibration of the nomo-gram model was assessed by Hosmer-Lemeshow inspection and calibration curves.Results The proportion of Qi deficien-cy pattern,Yin deficiency pattern,left atrial diameter(LAD),left ventricle diameter(LVD),and neutrophil to lymphocyte ratio(NLR)of patients with AF in the recurrence group were higher than those in the non-recurrence group,and the proportion of class Ⅲ antiarrhythmics,statins,and Yiqi-Yangyin TCM injections in the recurrence group were lower than those in the recurrence group(t/x2/P=6.355/0.012,7.149/0.007,5.445/＜0.001,3.063/0.002,3.499/0.001,10.542/0.001,12.122/＜0.001,6.362/0.012).Multiple regression analysis identified that non-paroxysmal AF,early recurrence,Qi deficiency pattern,Yin deficiency pattern,large LAD and large NLR were independent risk factors for late recurrence after the first RFCA in AF[OR(95％CI)=2.103(1.071-4.127),9.837(4.981-19.428),2.414(1265-4.603),2.460(1.317-4.596),1.117(1.047-1.192),1.377(1.077-1.761)],and the use of statins and Yiqi-Yangyin TCM injections were independent protection factors[OR(95％CI)=0208(0.104-0.413),0.416(0211-0.820)],and then construct a nomogram model.The verification results show that the area un-der of the ROC curve(AUC)for the prediction model was 0.863(95％CI=0.823-0.904).Conclusion Non-paroxysmal AF,early recurrence,LAD,NLR,Qi deficiency pattern,Yin deficiency pattern,use of statins,and use of Yqi-Yangyin TCM in-jections are independently associated with late recurrence after the first RFCA in AF.The prediction model based on the above independent influencing factors has high predictive power,and can be used to obtain the corresponding predictive value of the risk of late recurrence after RFCA of AF according to the individual conditions.
Atrial fibrillationRadio frequency ablationLate recurrenceColumn chartPrediction
万方数据
维普
