Risk factors for recurrence of persistent atrial fibrillation after radiofrequency ablation and correlation with plasma miRNA expression.

Abstract

Background: This study was to investigate the risk factors for recurrence after radiofrequency ablation (RFCA) in patients with persistent atrial fibrillation (PeAF) and analyse its correlation with plasma microribonucleic acid (miRNA) expression based on ultrasound cardiograms.

Methods: A total of 126 PeAF patients who underwent RFCA were selected as the research subjects (AF group), and 126 healthy subjects matched by gender and age were included as the control (control group). The basic data and biochemical indexes of the included research subjects were collected, and the subjects were followed up for one year after surgery. According to AF recurrence, all research subjects were divided into the recurrence group (45 cases) and the unpredictable group (81 cases). The t-test or Mann-Whitney U Test was adopted to compare B-type natriuretic peptide (BNP), uric acid (UA), glycosylated hemoglobin (HbA1c), and other biochemical indicators among patients in recurrence group and unpredictable group. In addition, left atrial diameter (LAD), left atrial volume (LAV), and left atrial ejection fraction (LAEF) were measured in both groups of patients. Logistic regression analysis was performed to identify the primary risk factors for recurrence among patients with PeAF after RFCA. Furthermore, the receiver operating characteristic (ROC) curve was used to compare the area under the curve (AUC) of the identified risk factors.

Results: AF duration in the recurrence group was shorter than that in the unpredictable group (P<0.01). The proportion of patients with a CHADS2 score of two or above in the recurrence group was significantly higher than that in the unpredictable group (P<0.05) in addition to UA (P<0.05) and BNP (P<0.001). Similarly, the LAD and LAV in the recurrence group were significantly higher (P<0.01), and LAEF was also found to be superior (P<0.05) in comparison to the unpredictable group. The relative expressions of plasma miRNA-150 and miRNA-133 of the patients in the AF group were remarkably reduced compared with those in the control group (P<0.05), while the relative expressions of miRNA-206, miRNA-21, miRNA-31, miRNA-27b, and miRNA-328 were all significantly increased (P<0.05) in contrast to those in the control group, and the plasma miRNA-21 (P<0.001) and miRNA-27b (P<0.05) expression of the patients in the recurrence group were significantly higher than that in the unpredictable group. AF duration (odds ratio (OR) = 1.182, 95% confidence interval (CI): 1.021~1.357), LAD (OR=2.066, 95% CI: 1.203~4.491), miRNA-21 (OR=1.253, 95% CI: 1.012-1.647), and miRNA-27b (OR=1.186, 95% CI: 1.006-1.391) were all correlated with recurrence among patients with PeAF after RFCA (P<0.05). The AUCs of AF duration, LAD, miRNA-21, and miRNA-27b LAD were found to be 0.654, 0.703, 0.795, and 0.815, respectively. The sensitivity values were 0.687, 0.701, 0.734, and 0.789, while the corresponding specificity values were 0.754, 0.732, 0.825, and 0.866, respectively. After AF duration, LAD and the expressions of miRNA-21 and miRNA-27b were combined as composite indexes, which resulted in an increased AUC (0.879), where the comparison with the AUC of a single index was significantly different (P<0.05).

Conclusions: AF duration, LAD, and the expressions of plasma miRNA-21 and miRNA-27b were the independent risk factors for recurrence among PeAF patients after RFCA.