阵发性房颤患者射频消融术后心电图P波离散度的变化

Changes of P wave dispersion on ECG in patients with paroxysmal atrial fibrillation after radiofrequency ablation

目的:探讨阵发性房颤射频消融术对P波离散度(最大、最小P波时限之差)的影响。方法:对95例有阵发性房颤病人行环肺静脉电隔离术,记录术前及术后24h十二导心电图,测量最大、最小P波时限,计算P波离散度。从术后3个月开始,每月门诊随访,并行动态心电图检查,随访6个月。根据房颤症状及动态心电图随访资料判断手术成功与否分为成功组(70例)和复发组(25例)。结果:所有房颤患者射频消融术后P波离散度较术前均有下降[(42.22±4.02)ms比(48.84±4.08)ms,P<0.01]。成功组P波离散度较术前明显下降[(40.67±4.82)ms比(47.63±3.58)ms,P<0.01],复发组较术前有所下降[(48.26±3.48)ms比(49.51±1.64)ms],但无显著性差异(P=0.346)。环肺静脉电隔离术后,成功组P波离散度显著低于复发组P波离散度(P<0.01)。结论:环肺静脉电隔离术可改善房颤患者P波离散程度,成功组P波离散度改善更加明显。环肺静脉电隔离术后P波离散度对房颤的复发有预测作用。

Objective：To explore the influence of radiofrequency ablation （RFA）on P-wave dispersion （difference between maximum and minimum P-wave interval）in patients with paroxysmal atrial fibrillation （PAF）.Methods：A total of 95 PAF patients underwent circumferential pulmonary vein isolation.The preoperative and postoperative 12-lead ECG were recorded for 24h,maximum P-wave interval （Pmax）and minimum P-wave interval （Pmin）were measured,and P-wave dispersion was calculated.Since three months after operation,patients received outpatient follow up and dynamic ECG every month for six months.The operation was judged for successful or not according to symptoms of atrial fibrillation and dynamic ECG results,and patients were divided into success group （n=70）and recurrence group （n=25）.Results：Compared with before operation,there was significant reduction in P-wave dis-persion [（48.84±4.08）ms vs.（42.22±4.02）ms,P 〈0.01]in all PAF patients after RFA.Compared with be-fore operation,there was significant reduction in P-wave dispersion [（47.63±3.58）ms vs.（40.67±4.82）ms,P〈0.01]in success group;and reduction in P-wave dispersion [（49.51±1.64）ms vs.（48.26±3.48）ms]in recur-rence group,but no significant difference （P =0.346）.After circumferential pulmonary vein isolation,P-wave dis-persion in success group was significantly lower than that of recurrence group （P 〈0.01）.Conclusion：Circumferen-tial pulmonary vein ablation can improve P-wave dispersion in patients with atrial fibrillation,and it＇s more signifi-cant for success group.P-wave dispersion can predict the recurrence of atrial fibrillation after circumferential pulmo-nary vein ablation.