摘要
目的:探讨心电图P 波离散度(Pd)联合QTc 间期预测阵发性房颤(PAF)射频消融术后早期复发的效能.方法:选取2019 年1 月至2023 年6 月PAF 患者 108 例,均行射频消融术,术后随访3 个月,根据是否复发分为复发组(28 例)与未复发组(80 例),比较两组基线资料、术前、术后 7d Pd、QTc及术前与术后7d Pd、QTc差值(△Pd、△QTc),分析Pd、QTc对术后早期复发的影响及预测效能.结果:复发组病程长于未复发组,高血压比例、CHA2DS2-VASc 评分高于未复发组(P<0.05);复发组术前、术后7d Pd(32.68±5.75)ms、(26.27±7.13)ms大于未复发组(28.51±5.04)ms、(17.16±6.28)ms,QTc(458.27±52.31)ms、(410.65±30.52)ms 长于复发组(430.19±39.62)ms、(372.06±25.40)ms(t=3.631、6.376、2.960、6.558,P 均<0.001);复发组术前与术后7d △Pd(6.41±2.67)ms、△QTc(47.62±10.33)ms小于未复发组(11.35±4.19)ms、(58.13±13.27)ms(t=5.828、3.803,P 均<0.001);术前Pd、QTc与CHA2DS2-VASc评分呈正相关(P<0.05);在校正病程、高血压、CHA2DS2-VASc 评分等其他因素前后,△Pd、△QTc均是PAF射频消融术后早期复发的独立影响因素(P<0.05);△Pd 预测 PAF 射频消融术后早期复发的AUC为0.779(95%CI:0.689～0.853),约登指数为 0.473,敏感度为 78.57%,特异度为68.75%;△QTc预测PAF射频消融术后早期复发的 AUC 为 0.715(95%CI:0.620～0.798),约登指数为0.411,敏感度为78.57%,特异度为 62.50%;△Pd、△QTc 联合预测 PAF 射频消融术后早期复发的 AUC为0.940(95%CI:0.878～0.977),约登指数为0.779,敏感度为92.86%,特异度为 85.00%,优于两者单独预测.结论:心电图Pd与QTc间期在PAF患者射频消融术前后的变化值联合预测术后复发的效能较高,能为临床防治提供相关指导信息.
Abstract
Objective:To investigate the efficacy of electrocardiogram(ECG)P-wave dispersion(Pd)combined with QTc interval in predicting early recurrence after radiofrequency ablation(RFA)for paroxysmal atrial fibrillation(PAF).Methods:A total of 108 PAF patients who underwent RFA from January 2019 to June 2023 were selected and followed up for 3 months after the operation.They were divided into a recurrence group(28 cases)and a non-recurrence group(80 cases)based on recurrence status.Baseline data,preop-erative and postoperative 7-day Pd,QTc,and the differences(△Pd,△QTc)between preoperative and post-operative 7-day Pd,QTc were compared between the two groups.The influence of Pd and QTc on early post-operative recurrence and their predictive efficacy were analyzed.Results:The disease course was longer,and the proportion of hypertension and CHA2DS2-VASc scores were higher in the recurrence group compared to the non-recurrence group(P<0.05).Preoperative and postoperative 7-day Pd(32.68±5.75)ms,(26.27±7.13)ms were higher than those in the non-recurrence group(28.51±5.04)ms,(17.16±6.28)ms,and QTc(458.27±52.31)ms,(410.65±30.52)ms were longer than those in the non-recurrence group(430.19±39.62)ms,(372.06±25.40)ms(t=3.631,6.376,2.960,6.558,all P<0.001).Preoperative and postoperative 7-day △Pd(6.41±2.67)ms,△QTc(47.62±10.33)ms were lower in the recurrence group than in the non-recurrence group(11.35±4.19)ms,(58.13±13.27)ms(t=5.828,3.803,all P<0.001).Preoperative Pd,QTc were positively correlated with CHA2DS2-VASc score(P<0.05).After adjus-ting for other factors such as disease course,hypertension,and CHA2DS2-VASc score,△Pd and △QTc re-mained independent influencing factors for early recurrence after PAF RFA(P<0.05).The AUC for △Pd in predicting early recurrence after PAF RFA was 0.779(95%CI:0.689-0.853),with a Youden index of 0.473,sensitivity of 78.57%,and specificity of 68.75%;for △QTc,the AUC was 0.715(95%CI:0.620-0.798),with a Youden index of 0.411,sensitivity of 78.57%,and specificity of 62.50%.The combined pre-diction of △Pd and △QTc for early recurrence after PAF RFA had an AUC of 0.940(95%CI:0.878-0.977),Youden index of 0.779,sensitivity of 92.86%,and specificity of 85.00%,which was superior to ei-ther predictor alone.Conclusion:The changes in ECG Pd and QTc interval before and after RFA in PAF pa-tients have high efficacy in predicting postoperative recurrence and can provide relevant guidance for clinical prevention and treatment.
基金项目
江苏省优势学科建设工程项目(YSHL1931-319)
国家科技期刊平台
NSTL
万方数据