P波离散度对阵发性心房颤动射频消融术后早期及晚期复发的预测价值

Predictive value of P wave dispersion in early and late recurrences of paroxysmal atrial fibrillation after radiofrequency ablation

目的研究P波离散度(P wave dispersion,Pd)与阵发性心房颤动(简称房颤)射频消融术后早期及晚期复发的关系,以及Pd对复发的预测价值。方法选取接受房颤射频消融术的阵发性房颤患者181例,对所有术后患者进行随访,平均随访(9.3±2.9)个月,并记录术后复发时间。分别在术前和术后1、3、6个月窦性心律时进行12导联心电图检查,测量P波时限,计算Pd,并分析Pd与房颤射频消融术后早期及晚期复发的相关性。结果早期复发定义为射频消融术后≤3个月时发作房颤、心房扑动(简称房扑);晚期复发定义为消融术3个月后发作房颤、房扑。阵发性房颤射频消融术后早期复发率为11.6%(21/181),晚期复发率为17.7%(32/181)。早期复发组与早期未复发组患者在术前、术后1个月Pd差异均有统计学意义(P<0.05);晚期复发组与晚期未复发组患者在术后6个月Pd差异有统计学意义(P<0.05)。多元Logistic回归分析结果表明,术前及术后1个月的Pd是房颤消融术后早期复发的独立危险因素,术后6个月的Pd是房颤消融术后晚期复发的独立危险因素。结论Pd可为预测房颤早期复发和晚期复发提供参考。

Objective To study the relationship between P wave dispersion(Pd)and early or late recurrence of paroxysmal atrial fibrillation(AF)after radiofrequency ablation,and to explore its predictive value on the recurrence.Methods We selected 181 patients with paroxysmal AF who had undergone radiofrequency ablation of AF.All the postoperative patients were followed up for an average of(9.3±2.9)months,and the recurrence time was recorded.Twelve-lead electrocardiogram examination was performed at sinus rhythm separately before operation,and 1 month,3 months and 6 months after operation.P wave duration was measured and Pd was calculated.The relativity between Pd and early or late recurrence of AF after radiofrequency ablation was analyzed.Results Early recurrence is defined as the onset of AF or atrial flutter≤3 months after radiofrequency ablation;late recurrence is defined as the onset of AF or atrial flutter more than 3 months after ablation.The early recurrence rate of paroxysmal AF after ablation is 11.6%(21/181)while the late recurrence rate is 17.7%(32/181).The difference of Pd is statistically significant between the early recurrence group and the non-early-recurrence group separately before ablation and one month after operation(P<0.05).There is a significant difference in Pd between the late recurrence group and the non-late-recurrence group 6 months after operation(P<0.05).Multivariate Logistic regression results show that Pd before ablation and 1 month after ablation is an independent risk factor for early recurrence after ablation of AF while Pd 6 months after ablation is an independent risk factor for late recurrence after AF ablation.Conclusion Pd could provide references for predicting the early and late recurrences of AF.