P波持续时间及E/e’对导管射频消融术后心房颤动复发的预测价值

Predictive value of P wave duration and E/e’ to recurrence of atrial fibrillation after radiofrequency catheter ablation

目的探讨P波持续时间(P wave duration,PWD)及E/e'对导管射频消融(Radiofrequency catheter ablation,RFCA)术后心房纤颤(房颤)(Atrial fibrillation,AF)复发的预测价值。方法连续入组2018年7月至2019年3月于徐州医科大学附属医院心内科行首次环肺静脉隔离(Pulmonary vein isolation,PVI)的房颤患者61例,所有患者均在CARTO 3系统引导下完成环肺静脉隔离(PVI)并成功恢复窦性心律,术后定期随访,观察患者是否有房颤复发。根据术后随访的结果,将患者分为复发组和成功组,探讨PWD及E/e'与房颤RFCA术后复发的关系。结果本研究RFCA术后平均随访6月,导管射频消融术后6月房颤复发14例,成功组47例。①复发组和成功组平均P波持续时间(mPWD)分别为:(141.93±16.75)ms和(118.55±13.75)ms,差异具有统计学意义(P<0.05)。复发组和成功组E/e'分别为(15.61±4.11)和(10.53±3.03),差异具有统计学意义(P<0.05)。②二元Logistic多因素回归分析显示,mPWD和E/e'可作为RFCA术后房颤复发的独立预测因素,OR值及95%可信区间分别为1.078,1.021~1.138,P=0.006和1.420,1.094~1.843,P=0.008。③分别绘制ROC曲线显示,mPWD和E/e'预测导管射频消融术后房颤复发的最佳截止值分别为127.5 ms和12,ROC曲线下面积(AUC)及95%可信区间(CI)分别是:0.870,0.773~0.951和0.846,0.738~0.958,敏感性、特异性、阳性预测值、阴性预测值和准确度分别为:85.7%,78.7%,54.5%,94.9%,80.3%和85.7%,72.3%,48.0%,94.4%,75.4%。结论PWD和E/e'可作为RFCA术后AF复发的独立预测因素。PWD>127.5 ms、E/e'>12的患者RFCA术后AF复发风险增高。

Objective To discuss the predictive value of P wave duration(PWD)and E/e'to recurrence of atrial fibrillation(AF)after radiofrequency catheter ablation(RFCA).Methods AF patients(n=61)undergone the first circumferential pulmonary vein isolation(PVI)were chosen from the Affiliated Hospital of Xuzhou Medical University from July 2018 to Mar.2019.All patients received PVI and successfully recovered sinus rhythm under the guidance of CARTO 3 system.The patients were followed up regularly after operation to observe whether there were cases with AF recurrence.According to the results of postoperative follow-up,the patients were divided into recurrence group and success group.The relationship among PWD,E/e,and AF recurrence after RFCA was investigated.Results The patients were followed up for 6 months averagely after RFCA,and there were 14 cases in recurrence group and 47 in success group.①The mean PWD(mPWD)was(141.93±16.75)in recurrence group and(118.55±13.75)in success group(P<0.05).E/e'was(15.61±4.11)in recurrence group and(10.53±3.03)in success group(P<0.05).②The results of binary Logistic multivariate regression analysis showed that mPWD(OR=1.078,95%CI:1.021~1.138,P=0.006)and E/e'(OR=1.420,95%CI:1.094~1.843,P=0.008)were independent predictive factors of AF recurrence after RFCA.③ROC curve showed that the best cutoff value of mPWD was 127.5 ms and that of E/e'was 12.AUC under ROC of mPWD was 0.870(95%CI:0.773~0.951),and that of E/e'was 0.846(95%CI:0.738~0.958).For mPWD,sensitivity was 85.7%,specificity was 78.7%,positive predictive value was 54.5%,negative predictive value was 94.9% and accuracy was 80.3%.For E/e',sensitivity was 85.7%,specificity was 72.3%,positive predictive value was 48.0%,negative predictive value was 94.4% and accuracy was 75.4%.Conclusion PWD and E/e'can be taken as the independent predictive factors of AF recurrence after RFCA,and the patients with PWD>127.5 ms and E/e'>12 have higher AF recurrence risks after RFCA.