持续性心房颤动消融终止部位心房电图的电压临界值研究

Cut-off value of atrial electrograms associated with termination of persistent atrial fibrillation by catheter ablation

目的确立持续性心房颤动(Ps AF)消融终止部位心房电图的电压临界值。方法回顾性分析2015年1月~2015年8月于北京朝阳医院行射频消融术的75例Ps AF患者,根据消融时Ps AF是否终止分消融终止组和消融未终止组,比较消融终止部位和消融未终止部位的心房电图特点和电压值,应用ROC曲线确定消融终止部位的电压临界值。结果消融终止部位的心房电图表现三种类型:无等电位线的连续电激动、有等电位线的连续电激动、复杂碎裂电图,平均电压值分别是(0.16±0.08)m V、(0.23±0.10)m V、(0.20±0.16)m V,无统计学差异(P>0.05)。Ps AF消融终止部位的电压值低于消融未终止部位的电压值,有统计学差异[(0.19±0.10)m V vs.(0.33±0.15)m V,P<0.01]。消融终止部位的心房电图的电压临界值为0.33 m V,敏感性、特异性分别是91.7%和55.6%,ROC曲线下面积为0.79(P<0.01)。结论 Ps AF消融终止部位的心房电图呈低电压特点,低电压心房电图的电压临界值对选择合适的心房电图进行消融有重要意义。

Objective To determine the cut-off value of atrial electrograms predictive of termination of Persistent atrial fibrillation（Ps AF） during ablation. Methods Seventy-five consecutive patients undergoing catheter ablation of Ps AF were studied from January 2105 to August 2015 in Beijing Chaoyang Hospital. Voltage and electrograms characteristics in terminated sites defined as termination of AF were compared with those in non-terminated sites. ROC curve was delineated to define the cut-off value of LVAE. Results Targeted ablation electrograms in terminated sites characterized by： 1） uninterrupted continuous electrical activity; 2） interrupted continuous electrical activity; 3） complex fractionated activity. Mean voltage in targeted electrograms were 0.16 ± 0.08 m V, 0.23 ± 0.10 m V and 0.20 ± 0.16 m V, respectively（P〉0.05）. Mean voltage of final targeted electrograms in terminated sites was lower than that in non-terminated sites（0.19 ± 0.10 m V vs. 0.33 ± 0.15 m V, P〈0.01）. Cut-off value of atrial electrograms in terminated sites was 0.33 m V with high specificity and moderate sensibility（91.7% and 55.6%, respectively）. Area under curve of ROC curve was 0.79（P〈0.01）. Conclusion Catheter ablation at sites displaying a lower voltage electrograms is associated with termination of Ps AF. The finding of cutoff value of Low-voltage atrial electrograms is important when choosing appropriate electrograms to ablate in Ps AF.