P波离散度对特发性阵发性房颤的预测价值

最近,有人［１］提出Ｐ波离散度（Ｐｄ）的概念,并指出Ｐｄ是预测特发性阵发性房颤（ＰＡＦ）的简单生理指标。作者对３０例发生过ＰＡＦ患者作回顾性分析,以探索Ｐｄ对ＰＡＦ的预测价值。１　对象与方法１１　临床资料　选择我院１９８９０５～１９９７０５３０例特发性ＰＡＦ的住院患者作为观察组。经体检、Ｘ线胸片、ＥＣＧ,ＵＣＧ、抗“０”、血沉检查,均正常,并对其进行至少１年以上项目的随访,均未发现异常,故诊断为ＰＡＦ。另选择我院２６名门诊体检人员为对照组,经１年以上的随访,未发生ＰＡＦ,上述项目的检查也均…     

P波离散度与阵发性心房颤动关系的研究

目的观察阵发性心房颤动（PAF）者的P波离散度（Pd）、P波最大时限（Pmax）、研究Pd及Pmax对PAF的预测价值。方法PAF者170例包括A组（特发性心房颤动88例）和B组（伴有高血压和/或冠心病者82例）,健康对照组（C组）108例,测量各组的Pd和Pmax,并以Pmax≥110ms和Pd≥40ms为标淮,评估Pd、Pmax和Pd＋Pmax对PAF的预测价值。结果A、B组Pd和Pmax增大（119.54±8.97ms,46.24±6.04ms）与C组（98.30±9.28ms,25.87±6.56ms）相比差异有显著性（P〈0.001）。Pmax≥110ms,Pd≥40ms及Pd≥40ms＋Pmax≥110ms时,预测PAF的敏度性分别为86.4%、83.5%、80.2%;特异性分别为84.4%、89.9%、92.8%;阳性预测准确度分别为83.8%、88.6%、91.0%。结论PAF者Pd明显增大,Pd是有效预测PAF的体表心电图的一个新指标。     

P波离散度与阵发性心房颤动的关系研究

目的 探讨体表心电图P波离散度（P-wave dispersion,Pdis）对阵发性心房颤动的预测价值。方法 对86例阵发性心房颤动病人（观察组）和同期54例健康成人（对照组）窦性心律时体表心电图的Pdis、P波最大时限（maximum P-wave duration，Pmax）进行测量分析。结果 观察组Pdis和Pmax与对照组比较,差异有统计学意义（P＜0.01）,Pdis或Pdis加Pmax对阵发性心房颤动有较高的特异度（81.5%,92.6%）和阳性预测价值（88.2%,94.6%）。结论 Pdis可作为预测阵发性心房颤动的一个可靠的体表心电图指标。     

阵发性心房颤动与P波离散度的关系

目的探讨P波离散度(Pd)与阵发性房颤的关系。方法观测62例高血压合并阵发性房颤患者(A组)和63例特发性房颤患者(B组)的pd和p波最大时限(Pmax)。结果两组阵发性房颤患者的Pd和Pmax与对照组比较有显著差异(P<0.05)。AB两组患者之间的Pd和Pmax无显著差异(P>0.05);Pd≥40ms、Pmax≥110ms及二者结合时,预测阵发性房颤患者的敏感性在AB两组结果分别是83.9%、85.5%、77.4%和81.0%、87.3%、79.4%,特异性分别是79.0%、71.0%、90.3%,阳性预测准确度分别是80.0%、74.6%、88.9%和79.7%、75.3%、89.3%。结论Pd是预测阵发性房颤的一个无创而可靠的新指标。     

特发性阵发性心房颤动患者P波离散度改变

为探讨特发性阵发性心房颤动患者Ｐ波离散度改变规律，观察４０例特发性阵发性心房颤动患者的最宽Ｐ波和Ｐ波离散度，并与３６例正常人对比分析。结果显示：阵发性心房颤动虱Ｐｍａｘ，Ｐ波离散度与对照组比较差异均有显著意义；阵发性心房颤动虱Ｐｍａｘ≥１１０ｍｓ，Ｐ波离散度≥４０ｍｓ者显著高于对照组。     

P波最大时间及离散度预测特发性心房颤动的价值

为探讨Ｐ波最大时间及其离散度对特发性心房颤动的预测价值,观察２０例特发性心房颤动患者及２０例健康者１２导联同步体表心电图Ｐ波最大时间及离散度。结果显示：特发性心房颤动组Ｐ波最大时间及离散度均较对照组增大（Ｐ〈０．０１）,Ｐ波最大时间〉１１０ｍｓ、Ｐ波离散度〉４０ｍｓ以及两者相结合对特发性心房颤动预测的敏感性分析为９０＾、８５％、７５％,特异性分别为８０％、８５％和９０％。提示这两项指标可用于预测特     

P波离散度、P波最大时限与高血压病并发阵发性心房颤动的关系探讨

目的探讨P波离散度（Pwd）和P波最大时限（Pmax）与高血压病并发阵发性心房颤动（PAf）的关系。方法将186例高血压病患者分为两组：A组96例,为并发PAf者;B组90例,为无PAf者。两组均行标准12导联心电图及彩色多普勒超声心动图（UCG）检测,均测量Pmax,P波最小时限（Pmin）及Pwd（Pwd=Pmax-Pmin）。结果A组Pmax、Pwd、左房内径与B组比较均有显著性差异（P〈0.01,P〈0.01,P〈0.05）。结论Pwd和Pmax可作为预测高血压病并发PAf的可靠预测指标。     

特发性阵发性心房颤动患者P波离散度的研究

Ｐ波离散度反映心房内不同部位存在非均质性电活动 ,它和最大Ｐ波时限一样是预测心房颤动 (简称房颤 )的体表心电图的一个新指标。本研究在体表心电图的基础上 ,结合食管导联心电图 ,探讨特发性阵发性房颤患者最大Ｐ波(Ｐｍａｘ)、Ｐ波离散度情况。1996年～ 2 0 0 0年 12月就诊的特发性阵发性房颤患者 46例 ,男 36例、女 10例 ,年龄 46± 8(2 6～ 6 9)岁 ,房颤病史 8±3 .0 4(1～ 14)年 ,每年发作 1～ 16次 ,持续约 4ｍｉｎ～ 4天。对照组 38例 ,男 2 7例、女 11例 ,年龄 44± 6 (16～ 70 )岁 ,均无房颤病史。两组患者经病史、体检、Ｘ线胸…     

P波离散度对特发性阵发性心房颤动的预测价值

观察特发性阵发性心房颤动 (IPAF)患者P波离散度 (Pd)和P波最大时限 (Pmax)的变化 ,探讨Pd、Pmax对IPAF的预测价值。IPAF患者 38例 (IPAF组 ) ,健康对照组 40例 ,测量两组的Pd和Pmax,并以Pmax≥ 110ms和Pd≥ 40ms为标准 ,评估Pd、Pmax和Pd +Pmax对IPAF的预测价值。结果 :IPAF组的Pmax和Pd分别为 12 8.3± 17.4,5 1.1± 11.9ms ,而对照组分别为 10 2 .4± 9.2 ,2 8.7± 7.9ms,IPAF组较对照组显著增加 (P <0 .0 5 )。IPAF组的阳性率分别为 86 .8% ,84.2 %和78.9% ,而对照组分别为 2 2 .5 % ,17.5 %和 7.5 % ,IPAF组显著高于对照组 (P <0 .0 5 )。应用Pd或Pd +Pmax预测IPAF有较高的特异度和阳性预测值。结论 :IPAF可引起Pd和Pmax显著增高 ,Pd是预测IPAF的有效指标     

P波离散度预测阵发性心房颤动的研究

目的观察阵发性心房颤动（PAF）病人的体表心电图P波离散度（Pd）、最大P波时限（Pmax）的变化.研究Pd与Pmax对PAF的预测价值.方法观察和测量80例PAF病人（观察组）的Pd和Pmax.并与70名健康者（对照组）对照分析.结果 PAF组与对照组比较,Pd与Pmax均有统计学意义（P＜0.001）.结论 Pd是一种新的预测PAF的体表心电图指标.     

P波最大时间和P波离散度在高血压合并阵发性心房颤动患者中的变化

目的 探讨P波最大时间（Pmax）与P波离散度（Pd）对高血压合并阵发性心房颤动的预测价值.方法 记录高血压伴阵发性心房颤动（观察组,n=96）和高血压不伴阵发性心房颤动（对照组,n=94）患者的同步12导联心电图,测量Pmax、P波最小时间（Pmin）及 Pd、左心房内径（LAD）和左心室射血分数（LVEF）.结果 观察组的Pmax及Pd明显大于对照组（118.94±11.57vs97.53±9.59,51.39±9.74vs29.34±7.51）,差异均有统计学意义（均P＜0.05）;Pmax＞110ms、Pd＞40ms及两者相结合时预测阵发性心房颤动的敏感性分别为82.29%、77.08%和71.88%,特异性分别为77.45%、84.26%和89.37%,阳性预测值分别为73.72%、86.23%和91.54%.结论 Pmax和Pd在高血压合并阵发性心房颤动患者中明显增大,可作为预测阵发性心房颤动的有效指标.     

比索洛尔、稳心颗粒对阵发性房颤病人P波离散度的影响

目的探讨比索洛尔及稳心颗粒对阵发性房颤(PAF)病人P波离散度(Pd)的影响。方法将177例PAF病人,随机分为比索洛尔组(A组)、稳心颗粒组(B组)、比索洛尔联合稳心颗粒治疗组(C组)。观察比较A组、B组、C组间治疗前、治疗后6个月Pd水平的差异。结果治疗前A组、B组、C组Pd差异无统计学意义(P>0.05)。治疗后3组Pd较治疗前明显降低(P<0.05或P<0.01),治疗后A组、B组Pd差异无统计学意义(P>0.05),C组Pd明显低于A组、B组(P<0.01)。结论比索洛尔与稳心颗粒联用更有助于预防房颤的复发。     

缬沙坦对高血压并阵发性房颤患者P波离散度的影响

目的：评价缬沙坦对高血压并阵发性房颤（PAF）患者P波离散度（Pd）的影响。方法：选取215例高血压并发PAF患者,分成缬沙坦组（97例）和氨氯地平组（118例）,分别口服缬沙坦、氨氯地平治疗6个月。治疗前、后采用同步12导联体表心电图分别测量最大P波时限（Pmax）、最小P波时限（Pmin）,并计算出Pd值,比较其差异性。结果：两组Pd和Pmax均显著缩短（P〈0．01）,但缬沙坦组比氨氯地平组缩短更明显（P〈0．01）。缬沙坦组发生PAF17例（17．5％）;氨氯地平组发生PAF 52例（44．1％）（P〈0．01）。结论：在同等降压条件下,缬沙坦能明显缩短Pd,降低PAF发生率。     

P Wave Dispersion and P Wave Duration on SAECG in Predicting Atrial Fibrillation in Patients with Acute Myocardial Infarction

Background: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI), with reported incidence of 7% to 18%. The incidence of congestive heart failure, in‐hospital mortality, and long‐term mortality is higher in AMI patients with AF than in AMI patients without AF. P wave duration on signal‐averaged ECG (PWD) and P wave dispersion on standard ECG (Pd) are noninvasive markers of intra‐atrial conduction disturbances, which are believed to be the main electrophysiological cause of AF. Methods: In the present study we investigated prospectively whether P wave duration on SAECG and P wave dispersion on standard ECG can predict development of AF in a group of patients with AMI. One hundred and thirty patients (100 men and 30 women, aged 56.9 ± 12) with AMI were investigated. PWD, Pd, their clinical and hemodynamic characteristics were collected. Results: During the observation up to 14 days, 22 patients (16.9%) developed AF. Univariate analysis variables associated with development of AF: age > 65 years, Killip class III‐IV, PWD > 125 ms, and Pd > 25 ms. Stepwise logistic regression analysis showed that age > 65 years, PWD > 125 ms, and Pd > 25 ms were independently associated with AF. Conclusions: PWD and Pd both measured in a very early period of AMI are useful in predicting AF. A.N.E. 2002;7(4):363–368     

P Wave Dispersion: A Valuable Electrocardiographic Marker for the Prediction of Paroxysmal Lone Atrial Fibrillation

Background: The prolongation of atrial conduction time and the inhomogeneous propagation of sinus impulses are well known electrophysiological characteristics in patients with paroxysmal atrial fibrillation. Methods: The aim of this study was to test the ability of a new ECG marker to discriminate between patients with a prior history of paroxysmal lone atrial fibrillation and healthy controls. Maximum P wave duration (Pmax) and the difference between the maximum and the minimum P wave duration, which was defined as P-wave dispersion (Pdisp) were calculated from the 12-lead surface ECGs of 75 patients with a history of paroxysmal lone atrial fibrillation and 50 age-matched healthy controls. Results: Pmax was in patients 122 ± 17 ms and in controls 101 ± 10 ms (t = 7.935, P > 0.001). Pdisp was in patients 48 ± 16 ms and in controls 29 ± 8 ms (t = 7.616, P > 0.001). A Pmax value of 110 ms separated patients from controls with a sensitivity 85%, a specificity 72%, and a positive predictive accuracy of 82%. A Pdisp value of 40 ms separated patients from controls with a sensitivity of 81%, a specificity of 80%, and a positive predictive accuracy of 85%. Conclusions: (1) Pmax and Pdisp values were found to be significantly higher in patients with a prior history of paroxysmal lone atrial fibrillation than in age-matched healthy controls, and (2) Pdisp is a new simple ECG marker that could be possibly used for the identification of patients with a previous history of paroxysmal lone atrial fibrillation. A.N.E. 1999;4(1):39–45     

P‐Wave Dispersion: A Novel Predictor of Paroxysmal Atrial Fibrillation

Background: The prolongation of intraatrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses are well known electrophysiologic characteristics in patients with paroxysmal atrial fibrillation (AF). Previous studies have demonstrated that individuals with a clinical history of paroxysmal AF show a significantly increased P‐wave duration in 12‐lead surface electrocardiograms (ECG) and signal‐averaged ECG recordings. Methods: The inhomogeneous and discontinuous atrial conduction in patients with paroxysmal AF has recently been studied with a new ECG index, P‐wave dispersion. P‐wave dispersion is defined as the difference between the longest and the shortest P‐wave duration recorded from multiple different surface ECG leads. Up to now the most extensive clinical evaluation of P‐wave dispersion has been performed in the assessment of the risk for AF in patients without apparent heart disease, in hypertensives, in patients with coronary artery disease and in patients undergoing coronary artery bypass surgery. P‐wave dispersion has proven to be a sensitive and specific ECG predictor of AF in the various clinical settings. However, no electrophysiologic study has proven up to now the suspected relationship between the dispersion in the atrial conduction times and P‐wave dispersion. The methodology used for the calculation of P‐wave dispersion is not standardized and more efforts to improve the reliability and reproducibility of P‐wave dispersion measurements are needed. Conclusions: P‐wave dispersion constitutes a recent contribution to the field of noninvasive electrocardiology and seems to be quite promising in the field of AF prediction. A.N.E. 2001;6(2):159–165     

厄贝沙坦联合胺碘酮对慢性心力衰竭患者P波离散度与阵发性心房颤动的影响

目的探讨厄贝沙坦联合胺碘酮对慢性心力衰竭(congestive hearts failure,CHF)的P波离散度与阵发性心房颤动的影响。方法选取90例CHF患者,采取随机数字表法分为对照组与观察组,每组各45例,两组均给予CHF基础用药,对照组在其基础上加用厄贝沙坦,观察组在对照组基础上加用胺碘酮治疗,疗程6个月,比较两组治疗前后P波离散度及阵发性心房颤动发生情况。结果两组治疗后与治疗前比较P波最大值及P波离散度降低,而观察组治疗后与对照组治疗后比较上述指标改善更加显著,差异具有统计学意义(P0.05)。两组治疗后与治疗前比较左心室舒张期内径(LVDd)降低,左心室射血分数(LVEF)升高,而观察组更加显著,差异均具有统计学意义(P0.05)。两组治疗后与治疗前比较心房颤动发作次数及心房颤动发生率降低,而观察组更加显著,差异均具有统计学意义(P0.05)。结论厄贝沙坦联合胺碘酮治疗CHF能够降低P波离散度,逆转左心室重构,降低阵发性心房颤动的发生频率。