P波振幅预测阵发性心房颤动肺静脉隔离射频消融术后复发的临床价值  

Clinical value of P wave amplitude in predicting postoperative recurrence of pulmonary vein isolation in patients with paroxysmal atrial fibrillation

作　　者：王学忠[1] 王岳松[1] 汪韶君[1] 樊琴[1] 邵旭武[1] 董学斌[1] 方永华[1] 

机构地区：[1]马鞍山市人民医院心内科,安徽马鞍山243000

出　　处：《中国介入心脏病学杂志》2016年第7期379-384,共6页Chinese Journal of Interventional Cardiology

摘　　要：目的 评价阵发性心房颤动（房颤）肺静脉隔离射频消融患者术前P波振幅与术后复发之间的关系.方法 回顾性分析接受肺静脉隔离射频消融治疗阵发性房颤患者的临床特征,测量相关导联P波的时限和振幅.术后随访3个月以上,按照术后复发与否分为复发组与未复发组,评估P波振幅在预测房颤术后复发中的价值.结果 在50例患者中术后共13例复发房颤,其中2例再次射频消融成功,总射频消融成功率78.0％（39/50）.复发组患者年龄[（67.75±6.48）岁比（60.82±8.87）岁,P=0.007]、CHA2 DS2-VASC评分[（2.21±1.25）分比（1.33±1.15）分,P=0.021]和左心房内径[（40.4±4.7）mm比（37.2±4.2）mm,P=0.028]均显著高于未复发组,差异均有统计学意义.复发组患者Ⅰ导联P波振幅[（0.065±0.038） mV比（0.095±0.038）mV,P=0.024]显著低于未复发组.Ⅰ导联P波振幅＜0.1 mV在预测阵发性房颤肺静脉隔离射频消融术后复发的敏感度为79％,特异度为71％.多元回归分析显示,Ⅰ导联P波振幅＜0.1 mV为房颤术后复发的独立危险因素（OR 2.36,95％ CIl.96～4.87,P=0.012）.结论 Ⅰ导联P波低振幅可能是预测阵发性房颤肺静脉隔离射频消融术后复发的有效指标.Objective To assess the clinical significance of the P-wave amplitude on standard 12 lead ECG in predicting the chance of AF recurrence in patients with paroxysmal atrial fibrillation （PAF）after successful pulmonary vein isolation （PVI）.Methods The clinical features of patients with atrial fibrillation after ablation were retrospectively analyzed.The duration and amplitude of P wave were measured in 12 leads,and its relation with the recurrence group and non recurrence group was analyzed.Results A total of 50 patients with PAF who underwent radiofrequency catheter ablation were included according to the inclusion criteria and thirteen patients suffered from AF recurrences 3 months or more after the PVI.Total ablation success rate was 78％.There were significant differences in terms of age [（67.75 ±6.48）vs.（60.82±8.87） years old,P=0.007],CHA2DS2-VASc score [（2.21 ±l.25）vs.（1.33±1.15）,P=0.021] and left atrial dimension [（40.4 ±4.7） mm vs.（37.2 ±4.2） mm,P =0.028]between the recurrence group and the non-recurrence group.The P wave amplitude in lead Ⅰ was significantly lower in the recurrence group [（0.065 ± 0.038） mV vs.（0.095 ± 0.038） mV,P =0.024] and had a sensitivity of 79％,specificity of 71％ in predicting paroxysmal atrial fibrillation recurrence after pulmonary vein isolation.Multiple regression analysis showed that the amplitude of P wave amplitude ＜ 0.1 mV in lead Ⅰ was independent risk factors for atrial fibrillation postoperative recurrence （OR =2.36,95％ CI 1.96-4.87,P =0.012）.Conclusions The low amplitude of P wave in lead Ⅰ may be an effective index to predict the recurrence of atrial fibrillation after pulmonary rein isolation.

关 键 词：P波振幅 阵发性心房颤动 肺静脉隔离 复发 

分 类 号：R541.75[医药卫生—心血管疾病]