摘要
目的 探讨体表心电图相关参数预测心房颤动(AF)射频消融术(RFCA)后复发的价值,并分析其临床意义.方法 选取2019 年1 月—2021 年8 月收治的542 例AF,均行RFCA术治疗,根据术后6 个月是否复发分为复发组(72 例)与未复发组(470 例),比较2 组临床资料、手术前后体表心电图相关参数[V1 导联f波平均振幅、P波时限(PWD)、最大P波时限(Pmax)、P波离散度(Pd)]及各参数变化差值,分析各参数变化差值与术后复发风险的关系及预测价值.结果 复发组年龄、右心房内径大于未复发组,病程长于未复发组,合并高血压病比例高于未复发组(P＜0.01).2 组术后1dV1 导联f波平均振幅长于术前,PWD、Pmax、Pd低于术前(P＜0.05);复发组术前、术后 1d V1 导联f波平均振幅短于未复发组,PWD、Pmax、Pd高于未复发组(P＜0.01).复发组V1 导联f波平均振幅、PWD、Pmax、Pd变化差值小于未复发组(P＜0.01).危险度分析显示,V1 导联f波平均振幅、PWD、Pmax、Pd变化差值为低值时会显著增加术后AF复发风险.受试者工作特征曲线分析显示,V1 导联f波平均振幅、PWD、Pmax、Pd变化差值联合预测术后复发的曲线下面积和95%CI分别为0.931 和0.907,0.951,大于各参数变化差值单独预测.结论 V1 导联f波平均振幅、PWD、Pmax、Pd变化差值对AF患者RFCA术后复发具有较强的预测价值,联合检测有利于预防术后复发.
Abstract
Objective To investigate the value of body surface electrocardiogram(ECG)-related parameters in pre-dicting the recurrence of atrial fibrillation(AF)after radiofrequency ablation(RFCA),and to analyze its clinical signifi-cance.Methods All 542 AF cases admitted from January 2019 to August 2021 were treated with RFCA,and divided into re-currence group(n =72)and non-recurrence group(n =470)according to presence of recurrence at 6 months after surgery.The clinical data,body surface ECG-related parameters[mean amplitude of f-wave in V1 lead,P-wave time duration(PWD),maximum P-wave duration(Pmax),P-wave dispersion(Pd)]and the difference in the change of each parameter were com-pared between the two groups,and the relationship between the difference in the change of each parameter and the risk of re-currence after surgery and its predictive value were analyzed.Results In the recurrence group,the age and right atrial inter-nal diameter were greater than those in the non-recurrence group,the duration of the disease was longer than that in the non-recurrence group,and the proportion of combined hypertension was higher than that in the non-recurrence group(P＜0.01).The mean amplitude of f-wave at 1 day after surgery in two groups was longer than that before surgery,while PWD,Pmax,and Pd were lower than those before surgery(P＜0.05).The mean amplitude of f-wave before and at 1 day after surgery in the re-currence group was shorter than that in the non-recurrence group,while PWD,Pmax,and Pd were higher than those in the non-recurrence group(P＜0.01).The difference in the mean amplitude of f-wave,PWD,Pmax and Pd in the recurrence group was less than that in the non-recurrence group(P＜0.01).Hazard analysis showed that the risk of postoperative AF re-currence was significantly increased when the difference in changes in mean amplitude of f-wave, PWD, Pmax, and Pd was low, with OR of 2.394, 2.578, 2.103, and 1. 913, respectively, and 95％ CI of 1. 991, 2. 878, 2. 202, 3. 019, 1. 790, 2. 472, 1.583 and 2.312, respectively. Analysis of the receiver operating characteristic (ROC) curves showed that the area under the ROC curve (AUC) and95％ CI were0.931 and0.907,0.951 respectively for the combined prediction of postop-erative recurrence by the difference in change in mean amplitude of f-wave, PWD, Pmax, and Pd, which were greater than that predicted by the difference in change in each parameter alone. Conclusion The difference in mean amplitude of f-wave, PWD, Pmax and Pd has a strong predictive value for postoperative recurrence in AF patients with RFCA. Combined detection is beneficial to prevent postoperative recurrence and improve postoperative life quality of patients.
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