Introduction
Atrial fibrillation (AF) is the most common type of arrhythmia in
clinic. Patients with atrial fibrillation have an increased risk of
stroke, heart failure, and depression, which seriously affects the
patient’s life quality[1] and increases social
burden. For patients with paroxysmal atrial fibrillation (PAF), circular
pulmonary vein radiofrequency ablation (CPVA) is recommended as a
category I treatment[2]. Ablation therapy can
improve the left atrium remodeling in AF
patients[3]. Some observational studies suggest
that successful AF catheter ablation and maintenance of sinus rhythm are
associated with a decrease in stroke risk. However, the recurrence rate
after atrial fibrillation ablation procedure is high
(8%-40%)[4,5,6]. The results of ablation are
affected by many factors, such as left size, serum Galectin-3, serum
matrix metalloproteinase-9, etc [7-10], and the
mechanism of recurrence as well as the related factors are still
unclear, especially for PAF patients whose left atrium does not change
significantly. Identification of the indicators that can predict
recurrence after CPVA can help to develop more precise clinical
strategies.
During the progression of atrial fibrillation, AF patients often have
atrial remodeling, which is mainly manifested as atrial muscle
degeneration, fibrosis of atrial muscle and extracellular matrix; the
echocardiography often shows normal left ventricular ejection fraction
(LVEF) and left ventricle inner diameter, but the atrium is
enlarged[9], accompanied by varying degrees of
mitral regurgitation (MR). Normal mitral valve function depends on the
structural and functional integrity of the atria and ventricles. In
patients with isolated left atrial (LA) enlargement, when the mitral
valve annulus is not significantly expanded, the mitral valve closure
can be maintained by reducing the closure area and fornix height. But
after decompensation, atrial-related MR will occur. Ring et al. believed
that the percentage of systolic mitral valve antagonist area to the
overlapping area of front and rear leaves of the mitral valve
<13%, as measured by three-dimensional transesophageal
echocardiography, can be used to predict the occurrence of functional MR
(A/VF-MR)[11]. In 2017, the American Society of
Echocardiography and the Society of Cardiovascular Magnetic Resonance
issued the latest recommendations for non-invasive assessment of the
severity of MR[12], which better guides and
standardizes the imaging evaluation of MR.
The clinical management of AF should be individualized. The prediction
of risk factors is important for comprehensive management of atrial
fibrillation. Previous studies on post-radiofrequency prediction mostly
focused on methods assessing the left atrial structure and function of
AF patients. There was not any predictive model based on the degree of
mitral regurgitation in patients with AF. This study further combined
the parameters of left atrial structure, function, and degree of MR. We
constructed a joint prediction model by using real-time
three-dimensional echocardiography (RT-3DE) to evaluate the volume of
LA, using transesophageal echocardiograghy (TEE) to obtain the left
atrial appendage function parameters, and referring to the evaluation
criteria of MR recommended by the latest guidelines. We developed a
prediction model for the recurrence of PAF patients after CPVA based on
echocardiographic and clinical characteristics, and verify its
diagnostic efficacy in the verification group. This study provided a
basis for designing clinical management strategies for AF patients.
We present the following article in accordance with the PRISMA reporting
checklist.