通过腔内心电图测量心房传导时间对心房颤动复发的预测价值

Predictive value of atrial conduction time detected by intracadiac electrogram to atrial fibrillation recurrence

目的 探讨通过腔内心电图测量心房传导时间对持续性心房颤动(房颤)射频消融术后复发的预测价值。方法 选取2020年1月至2021年1月首次接受房颤射频消融术的持续性房颤患者178例,通过CARTO3系统测量总心房传导时间(P-CSd),右心房传导时间(P-CSp)及体表心电图最大P波宽度(MPWD),在术后1、3、6、9、12月行门诊或电话随访。以术后房颤复发为结局,分析房颤复发影响因素。结果 随访1年,复发58例(34.1%)。复发组患者房颤病程>5年比例、左心房内径、P-CSd、P-CSp、MPWD均高于未复发组(P<0.05)。以体质指数(BMI)、房颤病程、左心房内径为调整因素,Cox回归分析结果显示P-CSd、MPWD均是房颤复发的危险因素,HR(95%CI)分别为1.024(1.012~1.036)、1.017(1.002~1.032)。绘制预测房颤复发的ROC曲线,P-CSd较MPWD有更优的诊断价值,曲线下面积及其95%CI:0.703(0.620~0.785),取截断值113.5 ms,此时敏感度达62.1%,特异度达67.0%。Kaplan-Meier生存曲线发现P-CSd≥113.5 ms组复发率高于P-CSd<113.5 ms组(P<0.001)。结论 通过腔内心电图测量心房传导时间P-CSd的延长是持续性房颤射频消融术后复发的独立危险因素,P-CSd≥113.5 ms对预测持续性房颤患者消融术后复发有较高的价值。

Objective To discuss the predictive value of atrial conduction time detected by using intracadiac electrogram(IEGM) to recurrence of persistent atrial fibrillation(PeAF) after radiofrequency ablation(RFA).Methods PeAF patients(n=178) received firstly RFA were chosen from Jan.2020 to Jan.2021.The total atrial conduction time(P-CSd),right atrial conduction time(P-CSp) and maximum P-wave duration on body surface electrocardiogram(MPWD) were detected by using CARTO3 system.The patients were followed up in outpatient clinic or by telephone after the operation for 1 month,and 3,6,9 and 12 months.The influence factors of AF recurrence were analyzed taken postoperative AF recurrence as outcome.Results There were 58 cases of AF re recurrence(34.1%) after the patients followed up for 1 y.The percentage of patients with AF course>5,left atrial diameter(LAD),P-CSd,P-CSp and MPWD were all higher in recurrence group than those in non-recurrence group(P<0.05).The results of COX regression analysis showed that P-CSd(HR=1.024,95%CI:1.012~1.036,P<0.001) and MPWD(HR=1.017,95%CI:1.002~1.032,P=0.023) were risk factors taken BMI,AF course and LAD as correction factors.The results of ROC curve analysis showed that P-CSd had higher diagnostic value than MPWD,and AUC was 0.703(95%CI:0.620~0.785).When the cutoff value was taken as 113.5 ms,the sensitivity was 62.1% and specificity was 67.0%.The results of Kaplan-Meier survival curve analysis showed that recurrence rate was higher in group of P-CSd≥113.5 ms than that in group of P-CSd <113.5 ms(P<0.001).Conclusion The prolongation of P-CSd detected by using IEGM is an independent risk factor of PeAF recurrence after RFA,and P-CSd≥113.5 ms has a higher value of predicting PeAF recurrence after RFA.