体表心电图P_(max)P_d对阵发性房颤的预测价值

Predictive value of the indexes of body surface electrocardiogram for patients with paroxysmal atrial fibrillation

目的 探讨体表电生理指标对阵发性房颤患者的预测价值。方法 对 5 4例特发性房颤 (Ⅰ组 ) ,5 1例器质性心脏病伴阵发性房颤 (Ⅱ组 ) ,5 0例正常人 (Ⅲa组 )和 5 5例不伴房颤的器质性心脏病 (Ⅲb组 )用分规测量 12导联心电图的同一心动周期的P波时限。得到P波时限的最大值 (Pmax)和最小值 (Pmin) ,P波离散度 (Pd)。M型超声心动图测量左房内径 (LAD)和射血分数 (LVEF)。结果 Pmax在Ⅰ、Ⅱ组间P <0 .0 2 5 ,Ⅰ、Ⅲa组间P <0 .0 1,Ⅱ、Ⅲb组间P >0 .0 5 ;Pd 在Ⅰ、Ⅱ组间P <0 .0 5 ,Ⅰ、Ⅲa组间P <0 .0 5 ,Ⅱ、Ⅲb组间P >0 .0 5 ;而Pmin在各组间无差异 ;LAD和LVEF在Ⅰ、Ⅱ组间P <0 .0 1,Ⅱ、Ⅲb组间和Ⅰ、Ⅲa组间无显著性差异。以Pmax≥ 115ms和 /或Pd≥ 4 5ms为阳性标准 ,其对特发性房颤的敏感性 72 .5 8% ,特异性 94 .36 % ,准确性88.6 4 %。结论 Pd 和Pmax对预测阵发性房颤是 2个有用的电生理指标 ,但不能将器质性心脏病伴阵发性房颤者从器质性心脏病者中区分出来 ,左房扩大和LVEF的降低是导致器质性心脏病合并阵发性房颤的主要影响因素。

Objective To determine the role of P wave duration and dispersion in the predictive value of paroxysmal atrial fibrillation. Methods patients were divided into 3 groups: 54 paroxysmal AF without organic heart diseases(groupⅠ),51 AF with organic heart diseases(group Ⅱ), 50 normal(groupⅢa) and 55 non-AF with organic heart diseases(group Ⅲb). 12-lead electrocardiogram (ECG), echocardiograms were obtained in all patients. We measured P wave duration and dispersion from 12-lead ECG in each patient.Results There was significant difference in P max between group Ⅰ and Ⅱ(P<0.025) , group Ⅰand Ⅲa(P<0.01). There was significant difference in P d between group Ⅰ and Ⅱ(P<0.05), group Ⅰand Ⅲa(P<0.01). There was no difference's in Pmin among 3 groups. LAD and LVEF between group Ⅰ and Ⅱ had a significant difference, but between group Ⅱ and Ⅲb, group Ⅰ and Ⅲa had no difference. Conclusion P d and P max are useful electrocardiogram indexes for predicting paroxysmal AF, but it can not distinguish the paroxysmal AF with organic heart diseases from organic heart diseases without AF. Enlarged LV and decreased LVEF are main factors of leading to paroxysmal AF in patients with organic heart diseases.