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When patients with Wolff-Parkinson-White(WPW) syndrome complicate with atrial fibrillation (AF), the rapid atrial impulse may pass through the manifested accessory pathway down to the ventricles, leading to a rapid ventricle rate or even ventricular fibrillation, causing cardiac arrest and sudden cardiac death. Our study aimed in analyzing the correlated factors in patients with pre-excitation syndrome complicated with AF, and providing clinical evidence for the vulnerable population of AF.
Patients who underwent electrophysiological studies and radiofrequency catheter ablation from Jan, 2010 to Dec, 2015 were enrolled. Data of the studied patients were collected including name, gender, age, left atrial diameter, left ventricular diameter, left ventricular ejection fraction, smoking, drinking, associated diseases (hypertension, diabetes, coronary heart disease, dyslipidemia), and the features of the accessory pathway. AF occurred during the electrophysiological studies or with a history of AF was defined as AF vulnerable patient.
Quantitative data were expressed as mean ± SD. The categorical data between the two groups are analyzed by χ2 test. T test or Wilcoxon signed rank test was used to analyze the differences in quantitative data. The logistic regression analysis was used to assess the relationships between AF and clinical features and the accessory pathway features. We used odds ratio (OR) with 95% confidence interval (CI) and p-values to describe the results of logistic regression. And P<0.05 was considered statistically significant.
There are totally 538 patients, 50 patients with AF and 488 patients without AF. And AF occurs in approximately 9.29% of patients with pre-excitation syndrome. And the χ2 test showed patients with AF are more likely to be male (OR 2.448, P=0.009), with a history of smoking (OR 2.256, P=0.007) and more likely to have manifest accessory pathways (OR 5.308, P<0.001) than patients without AF. There was no significant difference in age, drinking, left atrial diameter, left ventricular diameter, left ventricular ejection fraction and the location and number of accessory pathways and associated diseases between the two groups. And the univariable logistic regression analysis showed the same results. While the multivariable logistic regression analysis showed that male (OR 28.9, P<0.001) and manifest pathways (OR 45.0, P<0.001) were independent risk factors of patients with pre-excitation syndrome complicate with AF.
The prevalence of AF in pre-excitation syndrome is higher than normal people. Male and manifested accessory pathways were associated with an increased risk of AF, and smoking may be related to the occurrence of AF. However, the location and number of accessory pathways and age, drinking, left atrial diameter, left ventricular diameter, left ventricular ejection fraction and associated diseases are not critical in the pathogenesis of AF.