环肺静脉线性消融术对P波振幅及方向的影响

Changes in P-wave polarity and amplitude after circumferential pulmonary vein isolation

目的观察环肺静脉线性消融术前、术后P波的正负方向及振幅变化,探讨环肺静脉线性消融术对其的影响。方法 50例阵发性房颤患者,描记消融术前及术后7 d窦性心律下同步12导联心电图,分析各导联P波方向并测量相对应的振幅,术后定期根据症状及动态心电图随访判断手术成功与否。结果 P波正向波振幅在Ⅰ、Ⅱ、Ⅲ、aVF、V5、V6导联术后较术前明显降低(P<0.05);负向波振幅在aVR、aVF导联术后较术前明显降低(P<0.05);总振幅在Ⅰ、Ⅱ、aVR、V5、V6导联术后较术前明显降低(P<0.05)。P波极性术后Ⅲ导联负向波增多,aVL导联正向波增多。术前、术后P波正向振幅、负向振幅及总振幅在手术成功组与失败组间差异无统计学意义。结论环肺静脉线性消融术导致P波振幅明显降低,提示左心房整体除极电量下降;P波极性变化提示P波整体向量向右向下改变;P波振幅降低程度对手术成功与否无预测价值。

Objective To observe the influence of circumferential pulmonary vein isolation（CPVI） on P-wave polarity and amplitude and to investigate whether the changes of P-wave are associated with patient outcomes after initial CPVI.Methods Fifty patients with paroxysmal atrial fibrillation（AF） underwent CPVI.For each patient,electrocardiograph（ECG） recordings were taken before and 7 days after ablation.The P-wave polarities and amplitudes were analyzed.Successful CPVI was defined as freedom of symptomatic and asymptomatic AF at the end of two consecutive follow-ups.Results The amplitude of positive P-wave was significantly decreased in the leads of Ⅰ,Ⅱ,Ⅲ,aVF,V5,and V6 after ablation（P0.05）.The amplitude of negative P-wave was significantly decreased in the leads of aVR and aVF after ablation（P0.05）.The total amplitude of P-wave was significantly decreased in the leads of Ⅰ,Ⅱ,aVR,V5 and V6 after ablation（P0.05）.The negative P-wave in the lead of Ⅲ and the positive P-wave in the lead of aVL were increased after ablation.The amplitudes of negative,positive and total P-waves before and after ablation were not significantly different between successful CPVI（n=39） and failure CPVI（n=11） groups.Conclusion CPVI can result in noticeable reduction of P-wave amplitude in several leads of ECG,indicating the reduction of left atrial electric capacity.The changes of P-wave polarity indicate a P-wave vector shift.The reduction degree of P-wave amplitude has no predictive value for the success or failure of CPVI.