房颤患者立体心电图P环特点与射频消融术后复发的关系  

Relationship between three-dimensional electrocardiographic P ring features and atrial fibrillation (AF) recurrence after radiofrequency ablation in AF patients

作　　者：马君[1,2] 马长生[1] 李学文 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029 [2]北京市门头沟区医院ICU [3]山西大医院心内科,太原030001

出　　处：《解放军医学杂志》2013年第10期847-850,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的应用立体心电图(3D-ECG)分析房颤患者心房传导时间、传导方向及振幅的变化与房颤射频消融术后复发的关系。方法纳入2009年12月-2010年3月在北京安贞医院确诊房颤并进行射频消融术的患者42例。分别在患者射频消融术术前及术后采集窦性心律3D-ECG并同步获取12导联心电图,分析每位患者射频消融术前、术后心房传导时间,P环除极方向及振幅与射频消融术术后复发的关系。查阅入选患者病历资料获取此次射频消融术术前心脏超声心动图左房内径数值及患者病史年限等资料,分析该组数据与房颤发生和射频消融术后复发的关系。结果术后P环方位对房颤复发具有明显影响(P=0.027),P环方位异常者房颤复发风险是P环方位正常者的8.4倍;左房大小对房颤复发的影响亦有统计学意义(P=0.022);P环运行时间差对房颤复发的影响位于检验水准附近(P=0.058)。病史年限每增加1年,射频消融术后房颤复发的风险增加1.363倍。相关分析显示,右房直径与术后P环最大振幅呈正相关(P=0.044),随右房直径增加,术后P环最大振幅呈增大趋势。结论随着病史时间延长,心房传导时间延长,心房除极方位及振幅发生变化,房颤患者的心房发生电重构和结构重构,二者共同作用导致了房颤的发生与维持。Objective To explore the relation of the conduction time, conduction direction and amplitude of three- dimensional electrocardiogram （3D-ECG） to the recurrence after radiofrequency ablation in atrial fibrillation （AF） patients. Methods Forty-two patients diagnosed with AF and receiving radiofrequency ablation in Beijing Anzhen Hospital from December 2009 to March 2010 participated in the present study. 3D-ECG and synchronous 12-lead ECG of sinus rhythm was recorded before and after radiofrequency ablation to analyze the correlation between the recurrence of AF after radiofrequency ablation and atrial conduction time, depolarization direction or amplitude of P ring. Meanwhile, the left atrial diameter determined by echocardiography before ablation and medical history were recorded, and the relationship between these data and both the occurrence of AF and recurrence after ablation was analyzed. Results The azimuth of P ring after surgery could significantly affect the recurrence of AF （P=0.027）, and the recurrence risk in patients with abnormal azimuth of P ring was 8.4 times that in patients with regular azimuth. The left atrial diameter could also significantly affect the recurrence （P=0.022）, while the influence of the difference in P ring response duration on AF recurrence was near the significant level （P=0.058）. The risk of AF recurrence increased 1.363-fold with each one additional year of AF history. A positive correlation was found between the right atrial diameter and maximal amplitude of P ring （P=0.044）. Conclusion With the development of AF, atrial conduction time become longer, and atrial depolarization azimuth and amplitude change, then the atrial electrical and anatomical remodeling occur, and both of them could lead to the occurrence and maintenance of AF.

关 键 词：心房颤动 导管消融术 电重构 结构重构 

分 类 号：R541.7[医药卫生—心血管疾病]