永久起搏器患者中QRS宽度与心房颤动的关系  

Association between QRS Duration with Atrial Fibrillation in Patients with Permanent Pacemaker

作　　者：邢福威 江竞舟 胡晓亮[1] 冯冲[1] 何建桂[1] 董吁钢[1] 马跃东[1] 唐安丽[1] XING Fu-wei;JIANG Jing-zhou;HU Xiao-liang;FENG Chong;HE jian-Gui;DONG Yu-Gang;MA Yue-dong;TANG An-li(Department of Cardiology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院心血管科,广东广州510080

出　　处：《中山大学学报（医学版）》2018年第4期618-625,共8页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：中山大学"5010计划"(2007011)

摘　　要：【目的】探讨永久性起搏器患者的起搏QRS波宽度(QRSd)与术后心房颤动(AF)发生的关系。【方法】我们回顾收集了180例因完全性/进展性房室传导阻滞而行永久性起搏器植入术的患者。所有的患者都是右室间隔部起搏。心电图在术前和术后都有记录。QRSd在部分胸前导联(V1,V4和V6)、I导联和AVF导联都有测量,QRS波差值由术后起搏QRSd减去术前QRSd获得。【结果】AF发生在64(35.56%)例患者中。AF发生组和没有AF发生组间,术前的QRSd相比没有统计学差异,但QRSd差值在V4导联(P=0.022)和V6导联(P=0.001)有统计学差异。COX比例风险模型提示V6导联的QRSd差值(P=0.005,HR 1.822,95%CI 1.174-2.718,QRSd的间隔区值定为40 ms)和左心房直径(P=0.045,HR 1.042,95%CI 1.001-1.086)是预测AF发生的独立危险因素。ROC曲线提示V6导联的QRSd差值可以预测AF的发生,尤其是术前QRSd较长的患者(≥120 ms,曲线下面积为0.826,95%CI 0.685-0.967)。【结论】V6导联的QRSd差值与术后AF的发生可能存在正相关关系。【Objective】To explore the association between paced QRS duration（QRSd）and the occurrence of atrial fibrillation（AF）in the patients with permanent pacemaker.【Methods】We selected 180 consecutive patients underwent pacemaker implantation for complete/advanced atrioventricular block. All of patients were paced from the right ventricular septum. Electrocardiography recordings were obtained at the beginning and the end of pacemaker implantation. QRSd was measured in precordial leads（V1,V4 and V6）,I lead and AVF lead. The change value of QRSd was calculated by subtracting the pre-implantation QRSd from the post-implantation QRSd.【Results】The occurrence of AF was observed in 64（35.56%）patients. No significant differences in pre-implantation QRSd were observed between the AF occurrence and non-occurrence groups. The change value of QRSd in leads V4（P=0.022）,and V6（P=0.001）differed significantly between the occurrence and non-occurrence groups. Cox.s proportional hazard model suggested that change value of QRSd in lead V6（P=0.005,HR 1.822,95%CI 1.174-2.718,interval scale of QRSd was 40 ms）and left atrial diameter（P=0.045,HR 1.042,95%CI 1.001-1.086）were independent risk factors for AF occurrence. Receiver operating characteristic curve suggested that change value of QRSd in lead V6 could predict AF occurrence,especially for patients with long pre-implantation QRSd（≥ 120 ms,area under the curve was 0.826,95%CI 0.685-0.967）.【Conclusions】Changevalue of QRSd in lead V6 seems to be positive correlated with post-implantation AF occurrence.

关 键 词：心电图 QRS波宽度 心房颤动 起搏器 

分 类 号：R54[医药卫生—心血管疾病]