最大P波宽度及P波离散度对阵发性房颤环肺静脉隔离术后复发的预测作用

目的探讨最大P波宽度(Pmax)及P波离散度(Pd)对阵发性心房颤动(房颤)环肺静脉隔离术后复发的预测作用(circumferential pulmonary vein ablation,CPVA)。方法 69名因阵发性房颤接受环肺静脉隔离术的患者,在术前和术后窦性心律时分别测定记录Pmax和Pd,并对患者进行随访,了解其复发情况。结果随访8～36个月,共有16名患者房颤复发,复发组和无复发组在年龄、性别、病程、基础疾病、左房内径(LA)、左室舒张末期内径(LVed)、射血分数(EF)上差异均无统计学意义;两组术前及术后Pmanx、Pd差异均无统计学意义,但术前和术后Pmax及Pd在复发组均有高于无复发组的趋势。复发组术后Pmax小于术前(P<0.05),而无复发组术后Pmax、Pd及复发组Pd均有小于术前的趋势。结论 Pmax及Pd对预测阵发性房颤消融术后复发的作用尚不能确定,但左房内消融可能影响了折返激动的形成。仍需大规模临床试验进一步评价体表心电图对预测房颤消融术后复发的价值,从而筛选复发高风险患者,予以干预措施,减少CPVA术后房颤复发。

Predictive effect of maximum P-wave duration and P-wave dispersion for paroxysmal atrial fibrillation recurrence after circumferential pulmonary vein ablation

Objective To investigate the predictive effect of maximum P-wave duration(Pmax) and P-wave dispersion(Pd) for paroxysmal atrial fibrillation recurrence after circumferential pulmonary vein ablation.Methods 69 patients with paroxysmal atrial fibrillation suffered from circumferential pulmonary vein ablation.The Pmax and Pd were measured in sinus rhythm before and after ablation,and the information of recurrence obtained by follow-up.Results During following-up 8 to 36 months,there were 14 patients recurrent.There were no statistic difference of age,gender,course of disease,basic disease,left atrial diameter(LA),left ventricular end diastolic diameter(LVed) and ejection fraction(EF) between recurrence group and no-recurrence group.And there were no statistic difference of Pmax and Pd before and after ablation between recurrence group and no-recurrence group,but there was the tendency which Pmax and Pd before and after ablation in recurrence group were longer than in no-recurrence group.Moreover,in recurrence group Pmax was less after ablation than before ablation(P<0.05).And there was the tendency which Pd after ablation in recurrence group less than before ablation,as well as the change of Pmax and Pd in no-recurrence group.Conclusion It does not determine the predictive effect of the Pmax and Pd for paroxysmal atrial fibrillation recurrence after ablation.But it showed ablation in left atrium should affect the formation of reentry.So in order to discover patients of high-risk of recurrent,who want to intervention in advance for decreasing recurrence,it is necessary that large scale clinical trials to evaluate the predictive effect of the electrocardiogram for recurrence of atrial fibrillation after ablation.