阵发性房颤患者心电图P波形态的分析

The predictive value of P wave characteristics on surface ECG to the incidence of paroxysmal atrial fibrillation

目的探讨体表心电图P波形态与阵发性心房颤动(PAF)的关系。方法选择52例非瓣膜性阵发性房颤患者及47例无PAF的对照组患者,测定窦性心律时12导联心电图P波离散度(Pd),最大P波时限(Pmax),V1导联P波终末电势(PtfV1)及aVR导联P波面积和振幅,超声心动图测定左房内径(LAD)、左室舒张末期内径(LVD)和左室射血分数(LVEF),分析PAF的敏感性、特异性、阳性预测值、准确度。结果与无PAF组相比,PAF组Pd和Pmax均显著增加,aVR导联负向P波振幅,P波面积及PtfV1则显著低于对照组。Pmax>100ms预测PAF的敏感性76.92%,特异性68.08%;Pd≥40ms预测PAF的敏感性80.77%,特异性78.72%;PtfV1≤-0.03mm.s预测PAF的敏感性67.31%,特异性61.70%;aVR导联P波面积预测PAF的准确性69.70%,P波振幅预测PAF的准确性67.68%。LAD增大(>40mm)者,仅aVR导联预测PAF的准确性无下降。结论对心房无显著增大患者,Pmax和Pd预测PAF较准确;对心房显著增大患者,aVR导联P波面积和振幅预测PAF的准确性较好。

Objective To evaluate the predictive value of P wave characteristics on surface ECG to paroxysmal atrial fibrillation（PAF）.Methods Fifty-two patients with PAF and forty-seven patients without PAF were underwent to echocardiography assay and 12-lead surface electrocardiography（ECG）recording.P wave maximal duration（Pmax）,P wave dispersion（Pd）,P wave terminal force in lead V1（PtfV1）,P wave amplitude（Pamp）and P wave area（Parea）in lead aVR were measured in ECG.Sensitivity,specificity,positive predictive value（PPV）,and negative predictive value（NPV）in predicting PAF were provided.Results ①Compared with patients without PAF,Pmax and Pd were significantly high in patients with PAF,and PtfV1,Pamp and Parea in lead aVR were significantly lower.The index to predictive PAF,such as Pmax≥100ms,Pd≥40ms,PtfV1≤-0.03mm·s,Pamp and Parea in lead aVR,were evaluated,with the sensitivity（76.92%,80.77%,67.31%,63.46% and 55.77%）,specificity（68.08%,78.72%,61.70%,76.60% and 80.85%）,PPV（72.73%,80.77%,66.03%,75% and 80.56%）,NPV（72.73%,78.72%,63.04%,62.30% and 65.45%）and accuracy（72.73%,79.80%,69.70%,64.65% and 67.68%）.In patients with left atrial diameter（LAD）≥40mm,predicting value of these P wave characteristics,except Pamp and Parea of aVR,significantly decreased.Conclusions In patients with normal LAD,Pmax and Pd may predict PAF;while in patients with enlarged LAD,Pamp and Parea have better predictive value.