心房颤动患者射频导管消融术后体表心电图P波的特征及临床意义

The features of P wave on surface electrogram in patients with atrial fibrillation after catheter ablation and its clinical significance

目的探讨不同类型心房颤动患者射频导管消融(下称消融)术后体表心电图P波特点与心律失常复发的关系。方法前瞻性纳入2018年10月至2019年10月行消融治疗的心房颤动患者,获取临床基线资料及术后多导电生理仪记录的12导联心电图,测量Ⅱ与V1P波时间(PWD)及振幅(PWA)、12导联P波时间最大值(PWDmax)、矢量振幅,比较不同类型心房颤动患者心电参数差异及与心房颤动复发的关系。结果共125例临床及心电资料完整的患者纳入最终分析,阵发性房颤患者75例(阵发性房颤组),持续性房颤患者50例(持续性房颤组)。经过8.5(6.03~11.70)个月随访,27(21.6%)例患者心律失常复发。与阵发性房颤组相比,持续性房颤组术后PWD-Ⅱ、PWD-V1及PWDmax显著增宽,PWA-V1及矢量振幅显著增高(均P<0.05)。与非复发者相比,复发者术后PWD-Ⅱ显著延长(P<0.05)。单因素Cox回归分析表明术后PWD-Ⅱ增宽与术后远期复发显著相关(HR=2.534,95%CI:1.137~5.647,P<0.05),以PWD-Ⅱ>148 ms为界值判断术后复发的灵敏度66.7%,特异度58.2%。结论持续性房颤消融术后心电图PWD-Ⅱ较长,这与心房颤动复发存在相关性。

Objective To analyze the P wave characteristic on surface electrogram(ECG) in patients with atrial fibrillation(AF)after radiofrequency ablation and its correlation with AF recurrence. Methods Clinical data and postoperative 12 lead ECG recorded using multi-channel electrophysiological recorder were collected from AF patients underwent radiofrequency ablation from October 2018 to October 2019. P wave duration(PWD) and amplitude(PWA) on lead Ⅱ and V1, maximal P wave duration(PWDmax)and vector amplitude from 12 leads were measured. These parameters were compared between different type of AF. The association between these ECG parameters and recurrence was evaluated. Results A total of 125 AF patients were enrolled. Of them, 75 cases were paroxysmal AF and 50 cases were persistent AF. After a mean follow-up of 8.5(6.03~11.70)months, the arrhythmias recurred in 27 patients(21.6%). PWD, PWDmax, PWA and vector amplitude were significantly greater in patients with persistent AF than with paroxysmal AF(all P<0.05). Compared with patient without AF recurrence, patients with AF recurrence had significant longer PWD in lead Ⅱ(P<0.05). Cox regression analysis suggested PWD of lead Ⅱ(HR=2.534, 95%CI:1.137~5.647, P<0.05) was an independent risk factor for arrhythmia recurrence. Taken lead Ⅱ PWD >148 ms as cut-off value, the sensitivity and specificity for predicting recurrence were 66.7% and 58.2%, respectively. Conclusion PWD in lead Ⅱ is longer in patients with persistent AF after ablation and associated with AF recurrence.