The impact of echocardiographic parameter ratio of E/E’ on the late recurrence paroxysmal atrial fibrillation in patients accepted radiofrequency catheter ablation

Abstract

This study aimed to evaluate the impact of the echocardiographic parameter ratio E/E’ on the late recurrence of paroxysmal atrial fibrillation in patients after receiving radiofrequency catheter ablation. We retrospectively examined total of 288 paroxysmal atrial fibrillation (PAF) patients that underwent a preliminary radiofrequency catheter ablation (RFCA) in our hospital. During the first phase in this study, the patients were divided into 2 groups upon AF recurrence after RFCA: Recurrent group, n = 67 patients with rapid trial arrhythmia that lasted for more than 30 seconds at 3 months after RFCA and the Nonrecurrent group, n = 221. The clinical conditions were compared between the 2 groups. During the second phase of this study, based on the results in the first phase, the patients were divided into another 2 groups according to whether the ratio of E/E’ ≥13 .45: Higher ratio of E/E’ group, n = 55 and Lower ratio of E/E’ group n = 233. The late AF recurrent rates were also compared between the 2 groups. During the first phase, the univariate analysis indicated that the risk factors( P < .05)for PAF late recurrence included early recurrence, E’, and the ratio E/E’. The Cox multivariate analysis showed that the ratio of E/E’ and early recurrence were the independent predictors for late PAF recurrence. The ratio of E/E’ that was cut off at 13.45 also predicted atrial tachyarrhythmia recurrence with 40.3% sensitivity and 87.3% specificity. In the second phase, after completing the 1:1 matching, the Kaplan–Meier analysis indicated that the ratio of E/E’ ≥ 13.45 was associated with further recurrences after RFCA (log-rank P = .009), compared to the patients with a ratio of E/E’ < 13.45. The univariate Cox analysis indicated that an elevated ratio of E/E’(≥13.45) was the independent predictor for late PAF recurrence (HR = 3.322, 95%CI: 1.560–7.075, P = .002). However, the ratio of E/E’ cut off at 13.25 predicted atrial tachyarrhythmia recurrence with 75% sensitivity and 62.2% specificity. The ratio of E/E’ ≥ 13.25 is an important predictor of the late recurrence of paroxysmal atrial fibrillation (PAF) after radiofrequency catheter ablation (RFCA).

Early Echocardiographic Predictors for Atrial Fibrillation Propensity: The Left Atrium Oracle

“…The E/E’ ratio, correlates to LA pressures and is associated with an increased risk of late AF recurrence after catheter ablation. The risk is 3.32 times higher for a threshold over 13.25 [ 75 ].…”

“…This ratio seems to have a clinical relevance in risk stratification in patients with AF. A ratio over 11.2 was determined as a predictor for early AF recurrences [ 55 ], while a higher ratio, over 13.25, was established as an independent predictor for late AF recurrences [ 75 ]. A septal E/E’ ratio over 15 was evaluated as an independent predictor of mortality in patients with AF [ 81 ].…”