P波离散度预测阵发性房颤及房性心律失常的价值

The prognostic value of p-wave dispersion in patients with paroxysmal atrial fibrillation and atrial arrhythmia

目的 探讨体表心电图P波离散度 (Pd)与阵发性 (含特发性 )心房颤动 (AF)及房性心律失常 (AR)的关系。方法 观察测量 5 2例AF和 5 0例AR患者P波离散度、P波最大时限 (Pmax)并与5 0例正常对照组对比分析 ,以上三组均按年龄分为≥ 60岁及 <60岁。结果 两年龄段的AF组、AR组分别与对照组比较则Pmax、Pd均有显著差异 (P <0 0 1) ,AF和AR组在年龄、各指标之间差异无显著性(P >0 0 5 )。Pd≥ 40ms,预测Af的敏感性为 65 % ,特异性为 88% ,阳性预测准确度为 85 % ,Pmax≥110ms ,预测AF敏感性为 75 % ,特异性为 60 % ,阳性预测准确度为 66% ,而当Pmax≥ 110ms+Pd≥ 40ms时 ,预测AF的敏感性及特异性为 44 %、92 % ,阳性预测准确度为 85 %。结论 体表心电图P波离散度是预测AF。

Objective To explore the relationship between p-wave dispersion(Pd) of surface electrocardiogram(ECG) and paroxysmal atrial fibrillation(AF) and atrial arrhythmia(AR).Methods The p-wave maximal interval(Pmax) and Pd were measured and compared in 52 patients with AF,50 patients with AR,and 50 healthy controls.All subjects were divided into two groups,one more than 60 years old,the other less than 60 years old.Results Pmax and Pd in AF and AR were higher than those in healthy controls in their respective age groups.The difference was significant (P<0.01).No significant difference existed in the indices of Pd and Pmax between AF and AR(P>0.05).Pd≥40ms and Pmax≥110ms separated patients from control group,with a sensitivity(65% and 75%),specificity(88% and 60%) and with positive predictive value of 85% and 66%.Pmax≥110ms coexisted with Pd≥40ms,Its sensitivity was 44%,specificity 92% and positive predictive value 85%.Conclusion Pd is a new,noninvasive,stable prognostic guideline in surface ECG in patients with AF and AR.