Abstract
OBJECTIVE: To explore the predictive value of echocardiographic parameters of left-ventricular diastolic function combined with electrocardiographic P-wave dispersion (PWD) for early recurrence of atrial fibrillation (ERAF) after radiofrequency catheter ablation (RFCA). METHODS: A total of 145 patients with atrial fibrillation who underwent their first RFCA at the Department of Cardiology, First Affiliated Hospital of Hainan Medical University, between January 2021 and December 2024, were enrolled in the study. The patients were followed up for 3 months after RFCA and divided into two groups, namely those with early recurrence and those without early recurrence. Within 2 h after the procedure, 12-lead electrocardiogram (ECGs) was recorded. The maximum P-wave duration (Pmax), minimum P-wave duration (Pmin), and PWD (the difference between Pmax and Pmin) were measured. Additionally, left-ventricular diastolic function parameters were obtained via echocardiography. RESULTS: ECG monitoring revealed ERAF in 45 patients (31.03%) at 3-month follow-up after RFCA. Spearman correlation analysis showed that ERAF positively correlated with PWD (r = 0.68, P < 0.001) and negatively correlated with Ea/Aa ratio (r = -0.49, P < 0.001). Under the combination of Ea/Aa < 1 and PWD, the area under the receiver operating characteristic (ROC) curve for the combined prediction increased to 0.95 [95% confidence interval (CI) = 0.91-0.98], with a Youden index of 0.73 (sensitivity 83.83%, specificity 88.88%). The incidence of ERAF was significantly higher in the group with Ea/Aa ratio <1 than in the group with Ea/Aa ratio ≥1 (66.07 vs. 9.09%, P < 0.001). The incidence of ERAF was significantly higher in the group with PWD ≥ 29.5 ms than in the group with PWD < 29.5 ms (65.08 vs. 4.88%, P < 0.001). Ea/Aa ratio and PWD were independently associated with ERAF [for Ea/Aa ratio, adjusted hazard ratio (HR) = 13.48, 95% CI = 3.49-52.05, P < 0.001; for PWD, adjusted HR = 0.23, 95% CI = 0.08-0.62, P = 0.037, respectively]. CONCLUSION: Left-ventricular diastolic dysfunction parameters and PWD can effectively predict ERAF after RCAF. Ea/Aa < 1 and PWD ≥ 29.5 ms are strong and independent predictors of ERAF.