房间阻滞预测阵发房颤消融术后复发  

Predictive value and significance of interatrial block in surface electrocardiogram in the recurrence after catheter ablation of paroxysmal atrial fibrillation

作　　者：胡正涛 张勇 佘飘飘 王俊 汪祥海 王德国 张凤祥[2] Hu zhengtao;Zhang yong;She piaopiao;Wang jun;Wang xianghai;Wang deguo;Zhang fengxiang(Department of Gerontology,First Affiliated Hospital of Wannan Medical College(Yijishan Hospital of Wannan Medical College),Wuhu,241001,China;Department of Cardiology,First Affiliated Hospital of Nanjing Medical University(Jiangsu Provincial People's Hospital),Nanjing,210029,China)

机构地区：[1]皖南医学院第一附属医院(弋矶山医院),241001 [2]南京医科大学第一附属医院江苏省人民医院,210029

出　　处：《临床心电学杂志》2021年第5期329-334,共6页Journal of Clinical Electrocardiology

基　　金：国家自然科学基金项目(编号:81670301)。

摘　　要：目的探讨体表心电图房间阻滞(Interatrial Block,IAB)对阵发性房颤(Paroxysmal Atrial Fibrillation,PAF)患者导管消融术后复发的影响及其临床意义。方法选择2013年1月至2018年12月在我院和江苏省人民医院住院并接受导管消融治疗的248例PAF患者连续随访2年,根据是否复发分成2组。术前窦性节律下采集并分析体表心电图P波时限、高度IAB发生率(P波时限>120ms,且下壁导联P波正负双向)。多元Logistics分析房颤复发的危险因素,生存分析评价IAB对房颤复发的影响。结果共计64例患者在随访中房颤复发(25.8%),房颤复发组高度IAB发生率显著高于非复发组(a IAB:43.7%vs. 17.3%;p<0.001)。多元Logistics分析显示高度房间阻滞(a IAB)是房颤复发的独立相关因素(OR=3.188, 95%CI:1.378-7.378,p=0.007)。以Kaplan生存分析表明术前心电图a IAB者房颤复发显著增加(p<0.001)。结论术前心电图伴有a IAB的PAF患者消融后复发率较高,是房颤复发的独立危险因素,因此体表心电图IAB分析可作为PAF消融后复发有价值的临床预测指标。Objective To investigate the impact and clinical significance of interatrial block(IAB) on paroxysmal atrial fibrillation(PAF) in patients after catheter ablation. Methods Two hundred and forty eight consecutive patients with PAF who hospitalized in our hospital and received catheter ablation were followed up for 2 years from January 2013 to December 2018. In all patients, P wave duration, the presence of advance IAB(a IAB), defined as a P-wave duration>120 ms and biphasic(+/-) morphology in the inferior leads, were analyzed pre-ablation under sinus rhythm from surface electrocardiogram(ECG). Multivariate Logistics was used to analyze the risk factors of AF recurrence, and Kaplan-Meier survival analysis was used to evaluate the impact of IAB on AF recurrence. Results A total of 64 patients had recurrence of AF during follow-up(25.8%). The incidence of IAB in the group of AF recurrence was significantly higher than that in the no-recurrence group(a-IAB: 43.7%vs. 17.3%;p<0.001). Multivariate Logistics analysis showed that a IAB was an independent relevant factor for AF recurrence(OR=3.188, 95%CI 1.378-7.378, p=0.007). Kaplan-Meier survival analysis showed a IAB in ECG from preoperative ablation significantly increased the recurrence of AF( p<0.001). Conclusions Patients with PAF and advanced IAB in surface ECG preoperative ablation had increased risk of AF recurrence rate after catheter ablation. Thus, IAB analysis from ECG can be acted as a valuable clinical predictor of PAF recurrence after catheter ablation.

关 键 词：阵发性房颤 房间阻滞 左心房内径 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]