Left Atrial Appendage Circular RNAs Are New Predictors of Atrial Fibrillation Recurrence After Surgical Ablation in Valvular Atrial Fibrillation Patients: a Case Control Study

Abstract Background: Atrial fibrillation recurrence after surgical ablation in valvular atrial fibrillation patients will increase the mortality and morbidity during follow-up. In this study, we attempted to evaluate the relationship between circular RNAs in left atrial appendage and atrial fibrillation recurrence to establish a predictive model for early intervention.Methods: A retrospective case control study of all patients who underwent surgical ablation during valve surgery was performed. The expression level of circular RNAs were detected in the left atrial appendage tissue after surgery. 24 hours Holter examination was used to evaluate the status of heart rhythm during follow-up. The independent risk factors of atrial fibrillation recurrence were analyzed by multivariate analysis. The predictive model of atrial fibrillation recurrence was visualized by Nomogram and was tested by receiver operating characteristic curve analysis. Kaplan-Meier analysis was performed to compare the rate of freedom from atrial fibrillation recurrence after surgery.Results: A total of 136 patients completed the research strategy from September 2018 to June 2019, 81 (59.6%) patients restored sinus rhythm and 55 (40.4%) patients experienced atrial fibrillation recurrence. Increased age (P=0.002), longer AF duration (P<0.001) and increased expression of circ 81906-RYR2 (P<0.001), circ 44782-LAMA2 (P=0.002), circ 418-KCNN2 (P=0.011) and circ 35880-ANO5 (P<0.001) were detected in atrial fibrillation recurrence group. Multivariate analysis revealed that increased age (odd ratio=1.072, P=0.006), longer AF duration (odd ratio=1.007, P=0.036) and increased expression of circ 81906-RYR2 (odd ratio=2.210, P<0.001) were independent risk factors for recurrence. The area under the curve was 0.77 and the cut-off value was 70 points of the predictive model. The results of Kaplan-Meier plots showed that patients over 70 points were more likely to suffer from atrial fibrillation recurrence during the follow-up.Conclusions: Circ 81906-RYR2 could be a new predictor of atrial fibrillation recurrence after surgical ablation. A predictive model consists of age, atrial fibrillation duration and expression of circ 81906-RYR2 was alternative for early intervention of atrial fibrillation recurrence.Trial registration: Retrospectively registered.