肺静脉隔离对阵发性心房颤动患者的P向量环影响

目的:分析阵发性心房颤动(AF)患者,肺静脉隔离(PVI)前后P向量环的变化,探讨PVI所致的局部心房电静止能否影响心房除极向量。方法:阵发性AF患者65例,采用肺静脉口外节段性隔离,于手术前后窦性心律时分别记录心电向量图,分析心房除极向量的P环总运行时间(Pd)、额面P环电压(Pfv)、横面P环电压(Phv)、右侧面P环电压(Psv),以及额面P环角度(Pfd)、横面P环角度(Phd)和右侧面P环角度(Psd)。65例患者术中均达即刻成功标准,无并发症发生。结果:PVI前后心电向量图P环各项指标无明显变化Pd为(113.3±1.4)msvs.(112.1±1.4)ms;Pfv为(0.15±0.01)mVvs.(0.15±0.01)mV;Phv为(0.11±0.00)mVvs.(0.12±0.00)mV;Psv为(0.14±0.01)mVvs.(0.14±0.01)mV;Pfd为(55.2±2.2)°vs.(53.0±1.7)°;Phd为(43.1±2.6)°vs.(45.9±2.7)°;Psd为(55.4±1.9)°vs.(54.4±2.0)°]。结论:PVI治疗阵发性AF,造成肺静脉所在的左心房部分心肌产生心电静止,不影响心房除极的P向量环变化。

Vectorcardiogram P loop parameters in assessment of treatment of paroxysmal atrial fibrillation by pulmonary vein isolation

AIM: To analyze the changes of vectorcardiogram (VCG) P-loop parameters before and after treatment of paroxysmal atrial fibrallation by segmental pulmonary vein isolation (SPVI), to examine the effect of local electrical still in left atrium by PVI on the vectorcardiogram P-loop parameters in atrial depolarization and to study the size of impaired atrium and the data concerned with atrial fibrillation palindromia. METHODS: Sixty-five patients (45 males, 23 females; average age 57±13 years) with paroxysmal atrial fibrillation were included in the study. Segmental PVI was performed around pulmonary vein ostium and atrial vector was measured by VCG before and after PVI during sinus rhythm. Duration of P-wave loop (Pd), voltage of P-wave loop on frontal, horizontal and sagittal plane (Pfv, Phv, Psv) and direction of P wave loop on frontal, horizontal and sagittal plane (Pfd, Phd, Psd) were recorded and analyzed. RESULTS: No significant changes were observed before and after PVI and the indexes of VCG P-loop parameters were Pd (113.3±1.4) msec and (112.1±1.4) msec; Pfv (0.15±0.01) mV and (0.15±0.01) mV; Phv (0.11±0.00) mV and (0.12±0.00) mV; Psv (0.14±0.01) mV and (0.14±0.01) mV; Pfd (55.2±2.2)° and (53.0±1.7)°; Phd (43.1±2.6)° and (45.9±2.7)°; and Psd (55.4±1.9)° and (54.4±2.0)° (P values were 0.56; 0.77; 0.44; 0.73; 0.87; 0.45 and 0.73, respectively). CONCLUSION: The local electrical still in left atrium induced by paroxysmal atrial fibrillation by pulmonary vein isolation has no effect on the VCG P-loop parameters in atrial depolarization.