Effect of one-stop procedure on late recurrence rate of atrial fibrillation and analysis of risk factors

  AIM   To study the late recurrence rate and risk factors of atrial fibrillation after one-stop procedure.

  METHODS  Included in this study were 318 patients with atrial fibrillation who were hospitalized in the Department of Cardiology of Tangdu Hospital from March 2019 to July 2021, among whom 82 cases received one-stop procedure (radiofrequency ablation combined with left atrial appendage occlusion) and 236 cases received simple radiofrequency ablation operation. Between the two groups, late recurrence of atrial fibrillation was compared and univariate and multivariate logistic regression were used to analyze the clinical characteristics of the patients with OR without late recurrent atrial fibrillation.

  RESULTS  There was no significant difference in age, sex, course of disease, BMI, CHA₂DS₂-VASc score, HAS-BLED score, type of atrial fibrillation, complications, left atrial diameter and left ventricular ejection fraction between one-stop ablation group and simple radiofrequency ablation group. Comparing the length of hospitalization between the two groups, the one-stop group was significantly longer than the single radiofrequency ablation group (8.4±2.8 vs. 6.7±2.1) days (P<0.01). Perioperative complications occurred in 9 cases (11%) in the one-stop group and 14 cases (6%) in the simple radiofrequency ablation group. There was no statistically significant difference between the two groups. Both the one-stop group and the simple radiofrequency ablation group were treated with antiarrhythmic and anticoagulant drugs after surgery. There was no statistically significant difference in drug use rates between the two groups. The early recurrence rate of postoperative AF in the one-stop group was higher than that in the radiofrequency ablation group (27% vs. 13%, P<0.01). There was no significant difference in the recurrence rate of late postoperative atrial fibrillation between the two groups. The results of multivariate logistic regression analysis showed that the course of atrial fibrillation (OR=1.014, 95% CI: 1.000~1.027, P=0.05), left atrial diameter (OR=1.182, 95% CI: 1.030~1.357, P<0.05), preoperative neutrophil to lymphocyte ratio (OR= 2.092, 95% CI: 1.146~3.819, P<0.05) and early recurrence of postoperative atrial fibrillation (OR=13.884, 95% CI: 3.215~59.962, P<0.01) were the late stage of postoperative atrial fibrillation in the one-stop group.Independent risk factors for recurrence.

  CONCLUSION  One-stop procedure is safe and effective and does not increase the risk of late recurrence of atrial fibrillation after radiofrequency ablation. The duration of atrial fibrillation, left atrial diameter, preoperative neutrophil lymphocyte ratio and early postoperative recurrence of atrial fibrillation are independent risk factors of late recurrence of atrial fibrillation after one-stop procedure.