P波时限预测阵发性心房颤动射频消融术后复发的价值  

Value of P Wave Duration in Prediction of Recurrence after Ablation in Paroxysmal Atrial Fibrillation Patients

作　　者：胡晓亮[1] 江竞舟 马跃东[1] 唐安丽[1] 

机构地区：[1]中山大学附属第一医院心血管内科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2016年第2期272-276,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：中山大学"5010计划"(2007011);广东省科技计划社会发展(2012B031800296)

摘　　要：【目的】探讨阵发性房颤患者P波时限对射频消融术后复发的预测意义。【方法】171例行环肺静脉隔离术的阵发性房颤患者,描记术前及术后心电图,测量Ⅱ、Ⅲ、a VF、V1导联P波时限,计算P波时限变化值。【结果】Ⅱ、Ⅲ、Ⅵ导联术后P波时限均小于术前(P<0.001)。依据随访情况,患者分为复发组32例及未复发组139例。复发组较未复发组在Ⅱ、Ⅲ、Ⅵ导联具有更小的P波时限变化值(P<0.01),两组术前、术后P波时限及其他临床指标无统计学差异;多因素分析显示更小的Ⅱ导联P波时限变化值(P<0.001,OR=0.73,95%CI 0.648-0.824)及Ⅲ导联P波时限变化值(P=0.006,OR=0.904,95%CI 0.840-0.972)均为房颤复发的独立危险因素。以Ⅱ导联P波时限变化值预测房颤复发优于Ⅲ导联(P=0.01)。以Ⅱ导联P波时限变化-2.21 ms为阈值可获得最佳诊断效能,此时敏感性和特异性为85.29%和83.94%。以Ⅱ导联P波时限变化0 ms为阈值,敏感性和特异性为65.62%和91.37%,【结论】Ⅱ导联P波时限变化值可更好的预测房颤术后复发。[ Objective ] To explore P wave duration to predict the recurrence postablation in paroxysmal atrial fibrillation patients. [ Methods ] Totally 171 paroxysmal atrial fibrillation patients undergoing circumferential pulmonary vein isolation were included in this study. The electrocardiogram before and after ablation were recorded. The P wave duration in lead Ⅱ, Ⅲ, aVF and V1 were measured, the change value of P wave duration were calculated. [Results] P wave duration was significantly shortened in lead Ⅱ, Ⅲ, and V1 after ablation （P 〈 0.001）. All patients were divided into recurrence group （n = 32） and non-recurrence group （n=139）. Compared with non-recurrence group, the change value of P wave duration in lead Ⅱ, Ⅲ, and V1 were smaller （P 〈 0.01 ）. There was no significant difference in P wave duration before or after ablation and other indications between two groups. Multivariate analysis showed that the smaller change value of P wave duration in lead Ⅱ （P 〈 0.001, OR = 0.73, 95% CI 0.648-0.824） and Ⅲ （P = 0.006, OR = 0.904, 95% CI 0.840-0.972） were independent predictors of atrial fibrillation recurrence. The change value of P wave duration in lead H is superior to lead m in predicting atrial fibrillation recurrence after ablation （P = 0.01 ）. Using -2.21ms as the best cutoff, change value in lead Ⅱ had a 85.29% sensitivity and a 83.94% specificity. Using Ores as the cutoff, the change value in lead Ⅱ had a 65.62% sensitivity and a 91.37% specificity. [Conclusion] Change value of P wave duration in lead Ⅱ can better predict atrial fibrillation recurrence after radiofrequency ablation.

关 键 词：心房颤动 射频消融术 心电图 

分 类 号：R54[医药卫生—心血管疾病]