V1导联P波终末电势和心房激动时间与伴有左房增大的心房颤动患者左房前壁基质的相关性研究

Association between the P wave terminal force in lead V1,atrial activation time and the left atrial substrate across the anterior wall in patients with atrial fibrillation and enlarged left atrial

目的探究在左房扩大的心房颤动(AF)患者中,左房前壁基质改变对窦性心律下12导联心电图V1导联P波终末电势(PTFV1)和心房激动时间(AAT)的影响。方法入选行经导管心内膜消融术且心房扩大的AF患者98例[73.5%为阵发性AF]。将患者分为3组:前壁线性消融组(20例),前壁低电压组(21例)和对照组(57例)。记录所有患者术后的常规12导联心电图,比较各组之间PTFV1和AAT。结果前壁线性消融组较对照组PTFV1减小,AAT延迟[PTFV1:(0.007±0.011)mm·s vs (0.034±0.038)mm·s,P=0.024;AAT:(152.8±40.9)ms vs(91.6±21.1)ms,P<0.001];前壁低电压组患者较对照组的PTFV1亦减小,AAT亦延迟[PTFV1:(0.008±0.014)mm·s vs (0.034±0.038)mm·s,P=0.048;AAT:(137.7±40.8)ms vs (91.6±21.1)ms,P<0.001]。前壁线性消融组和前壁低电压组的PTFV1和AAT差别无显著性。结论左房扩大的患者, PTFV1减小,AAT延长提示左房前壁基质异常。

Objective To investigate the impact of the abnormal left atrial(LA)substrate across the anterior wall on the P wave terminal force in lead V1(PTFV1)and atrial activation time(AAT)in patients with atrial fibrillation(AF)and enlarged LA.Methods Ninety-eight patients with AF and enlarged LA volume who underwent catheter ablation were divided into 3 groups:LA anterior wall linear ablation group(20 cases),LA anterior wall low voltage group(21 cases)and control group(57 cases).PTFV1 and AATwere compared among each group.Results Compared with the control group,PTFV1 was attenuated and AAT across the anterior wall was prolonged in both the LA anterior wall linear ablation group[PTFV1:(0.007±0.011)mm·s vs(0.034±0.038)mm·s,P=0.024;AAT:(152.8±40.9)ms vs(91.6±21.1)ms,P<0.001,respectively]and the LA anterior wall low-voltage group[PTFV1:(0.008±0.014)mm·s vs(0.034±0.038)mm·s,P=0.048;AAT:(137.7±40.8)ms vs(91.6±21.1)ms,P<0.001,respectively].There were no significant difference in PTFV1 and AAT between the LA anterior wall linear ablation and the LA anterior wall low-voltage group.Conclusion In patients with AF and enlarged LA,attenuated PTFV1 and delayed AAT could be an indicator of the abnormal substrate across the LA anterior wall.