P波心电指标预测心房颤动首次射频导管消融术后复发的价值

目的：射频导管消融（ RFCA）是心房颤动（房颤）主要的治疗手段，然而关于RFCA术后房颤复发的预测指标较少。本研究探讨预测房颤首次RFCA术后复发的较为实用的心电学指标。方法对172例在2009年至2010年首次在大连医科大学附属第一医院二部行RFCA术的阵发性房颤患者进行随访研究。测量术前最大P波时限（ P-max）、最小P波时限（ P-min）、P波离散度（ PWD）、PR间期及V1导联P波终末电势（ PtfV1），探讨PtfV1≥0．04 mV·s在预测首次行RFCA的阵发性房颤患者术后复发的价值。结果首次行RFCA患者分为复发组（57例）和未复发组（115例）。单因素分析显示心力衰竭、左心房内径、P-max、P-min、PtfV1≥0．04 mV·s与房颤复发显著相关，二元Logistic回归分析发现PtfV1≥0．04 mV·s是房颤复发的独立预测因素。 PtfV1≥0．04 mV·s与房颤的Kaplan-Meier曲线及ROC曲线均显示差异具有统计学意义。PtfV1≥0．04 mV·s对房颤复发预测的灵敏度为72．0%，特异度为73．9%。结论PtfV1≥0．04 mV·s能够很好地预测阵发性房颤首次RFCA术后复发，有一定的推广价值。

Value of P-wave related electrocardiography parameters in recurrence of atrial fibrillation after first radiofrequency catheter ablation

Objective Radio frequency catheter ablation （ RFCA） is a main therapy for atrial fibrilla-tion （ AF） . However, the recurrence of AF after RFCA is a common clinical problem. This research focused on evaluating the predictive value of P-wave related electrocardiography parameters in primary recurrence of atrial fibrillation after RFCA. Methods One hundred and seventy-two patients between 2009 and 2010 who were reverted to sinus rhythm by RFCA were consecutively enrolled in this study. The predictive value of P-wave ter-minal vector of V1 lead （ PtfV1 ）≥0. 04 mV·s in recurrence of RFCA was assessed after measurements of max-imum P-wave duration （ P-max） , minimum P-wave duration （ P-min） , P-wave dispersion （ PWD） , PR interval and PtfV1 before operation. Results There were two groups：recurrence group （57 patients） and no recurrence group （115 patients）. Univariate analysis showed heart failure, left atrial diameter, P-max, P-min, PtfV1≥0. 04 mV·s were relevant to the recurrence of AF. PtfV1≥0. 04 mV·s was the independent predictive factor after binary logistic regression analyzing. The Kaplan-Meier curve of PtfV1≥0. 04 mV·s revealed satisfactory clinical value as well as ROC curve. The sensitivity and specificity of PtfV1≥0. 04 mV·s in predicting AF was 72. 0% and 73. 9%,respectively. Conclusion PtfV1≥0. 04 mV·s had a good predictive value in recurrence of paroxysmal atrial fibrillation after first RFCA. Taking many advantages into consideration, it is well worth popularized application.