心电图P波离散度联合QTc间期预测阵发性房颤射频消融术后早期复发的效能  

The Efficacy of ECG P-Wave Dispersion Combined with QTc Interval in Predicting Early Recurrence After Radiofrequency Ablation for Paroxysmal Atrial Fibrillation

作　　者：尹微 刘文武 许铎 YIN Wei(Suzhou Hospital Affiliated to Nanjing University Medical School,Jiangsu Suzhou 215153,China)

机构地区：[1]南京大学医学院附属苏州医院,江苏苏州215153 [2]江苏省苏州中医医院心血管内科,江苏苏州215153

出　　处：《河北医学》2024年第6期1020-1025,共6页Hebei Medicine

基　　金：江苏省优势学科建设工程项目,(编号:YSHL1931-319)。

摘　　要：目的:探讨心电图P波离散度(Pd)联合QTc间期预测阵发性房颤(PAF)射频消融术后早期复发的效能。方法:选取2019年1月至2023年6月PAF患者108例,均行射频消融术,术后随访3个月,根据是否复发分为复发组(28例)与未复发组(80例),比较两组基线资料、术前、术后7d Pd、QTc及术前与术后7d Pd、QTc差值(^(△)Pd、^(△)QTc),分析Pd、QTc对术后早期复发的影响及预测效能。结果:复发组病程长于未复发组,高血压比例、CHA2DS2-VASc评分高于未复发组(P<0.05);复发组术前、术后7d Pd(32.68±5.75)ms、(26.27±7.13)ms大于未复发组(28.51±5.04)ms、(17.16±6.28)ms,QTc(458.27±52.31)ms、(410.65±30.52)ms长于复发组(430.19±39.62)ms、(372.06±25.40)ms(t=3.631、6.376、2.960、6.558,P均<0.001);复发组术前与术后7d^(△)Pd(6.41±2.67)ms、^(△)QTc(47.62±10.33)ms小于未复发组(11.35±4.19)ms、(58.13±13.27)ms(t=5.828、3.803,P均<0.001);术前Pd、QTc与CHA2DS2-VASc评分呈正相关(P<0.05);在校正病程、高血压、CHA2DS2-VASc评分等其他因素前后,^(△)Pd、^(△)QTc均是PAF射频消融术后早期复发的独立影响因素(P<0.05);^(△)Pd预测PAF射频消融术后早期复发的AUC为0.779(95%CI:0.689~0.853),约登指数为0.473,敏感度为78.57%,特异度为68.75%;^(△)QTc预测PAF射频消融术后早期复发的AUC为0.715(95%CI:0.620~0.798),约登指数为0.411,敏感度为78.57%,特异度为62.50%;^(△)Pd、^(△)QTc联合预测PAF射频消融术后早期复发的AUC为0.940(95%CI:0.878~0.977),约登指数为0.779,敏感度为92.86%,特异度为85.00%,优于两者单独预测。结论:心电图Pd与QTc间期在PAF患者射频消融术前后的变化值联合预测术后复发的效能较高,能为临床防治提供相关指导信息。Objective:To investigate the efficacy of electrocardiogram(ECG)P-wave dispersion(Pd)combined with QTc interval in predicting early recurrence after radiofrequency ablation(RFA)for paroxysmal atrial fibrillation(PAF).Methods:A total of 108 PAF patients who underwent RFA from January 2019 to June 2023 were selected and followed up for 3 months after the operation.They were divided into a recurrence group(28 cases)and a non-recurrence group(80 cases)based on recurrence status.Baseline data,preoperative and postoperative 7-day Pd,QTc,and the differences(^(△)Pd,^(△)QTc)between preoperative and postoperative 7-day Pd,QTc were compared between the two groups.The influence of Pd and QTc on early postoperative recurrence and their predictive efficacy were analyzed.Results:The disease course was longer,and the proportion of hypertension and CHA2DS2-VASc scores were higher in the recurrence group compared to the non-recurrence group(P<0.05).Preoperative and postoperative 7-day Pd(32.68±5.75)ms,(26.27±7.13)ms were higher than those in the non-recurrence group(28.51±5.04)ms,(17.16±6.28)ms,and QTc(458.27±52.31)ms,(410.65±30.52)ms were longer than those in the non-recurrence group(430.19±39.62)ms,(372.06±25.40)ms(t=3.631,6.376,2.960,6.558,all P<0.001).Preoperative and postoperative 7-day^(△)Pd(6.41±2.67)ms,^(△)QTc(47.62±10.33)ms were lower in the recurrence group than in the non-recurrence group(11.35±4.19)ms,(58.13±13.27)ms(t=5.828,3.803,all P<0.001).Preoperative Pd,QTc were positively correlated with CHA2DS2-VASc score(P<0.05).After adjusting for other factors such as disease course,hypertension,and CHA2DS2-VASc score,^(△)Pd and^(△)QTc remained independent influencing factors for early recurrence after PAF RFA(P<0.05).The AUC for^(△)Pd in predicting early recurrence after PAF RFA was 0.779(95%CI:0.689-0.853),with a Youden index of 0.473,sensitivity of 78.57%,and specificity of 68.75%;for^(△)QTc,the AUC was 0.715(95%CI:0.620-0.798),with a Youden index of 0.411,sensitivity of 78.57%,and specificity o

关 键 词：阵发性房颤 射频消融术 早期复发 心电图 P波离散度 QTC间期 预测效能 

分 类 号：R654.2[医药卫生—外科学]