P波离散度与阵发性房颤的关系探讨

目的探讨体表心电图P波离散度(Pwd)与心房纤颤(AF)的关系。方法81例AF患者,无器质性心脏病的AF患者36例为A组,合并器质性心脏病的AF患者45例为B组,测量其体表心电图的Pwd、P波最大时限(Pmax)并与45例健康对照组(C组)对比分析。以Pmax≥110ms和Pwd≥40ms为阳性标准,评估Pmax、Pwd和Pmax+Pwd对AF的预测价值。结果A组、B组分别与C组比较,Pmax、Pwd差异均有统计学意义(P<0.05),A组与B组比较无显著差异(P>0.05)。Pmax≥110ms时,预测AF的敏感性为85.6%,特异性为84.5%,阳性预测值为82.7%;Pwd≥40ms时,预测AF的敏感性为88.4%,特异性为89.7%,阳性预测值为85.9%:2个指标结合时预测AF的敏感性为78.7%,特异性为91.5%,阳性预测值为90.2%。结论体表心电图Pwd是预测房颤的有效指标,而当Pmax与Pwd相结合时预测房颤的特异性和准确性更高。

Relationship between P wave dispersion and paroxysmal atrial fibrillation

Objective To explore the relationship between P-wave dispersion （Pwd）of surface electrocardiogram （ECG） and paroxysmal atrial fibrillation （AF）. Methods Eighty one AF patients were selected and divided into two groups： group A included 36 patients without heart disease and group B included 45 patients with heart disease. 45 healthy people were selected as controls （group C）. The P-wave maximal interval （Pmax）and Pwd were measured from 12-lead surface ECG. The predietive value of Pmax ,Pwd and combining the two targets were evaluated using Pmax≥110 ms and Pwd≥40 ms as the criteria. Results Pmax, and Pwd in group A and group B were significantly higher than those in group C（ P 〈 0.05）. No significant difference existed in A and B groups（ P 〉 0.05）. Pmax≥110 ms and Pwd≥40 ms separated patients from control group, with a sensitivity （85.6% and 88.4% ）, specificity （84.5% and 89.7% ） and with posit!re predictive value of 82.7 % and 85.9%. When Pmax≥ 110 ms combined with Pwd t〉 40 ms, its sensitivity was 78.7 %, specificity 91.5 % and positive predictive value was 90.2 %. Conclusion Pwd is an effective ECG marker to predict AF and Pmax ＋ Pwd has higher predictive value.