F波振幅对持续性房颤射频消融术后复发预测价值研究

【作者】 余敏；

【导师】 方全；

【作者基本信息】 北京协和医学院 ， 临床医学， 2012， 博士

【摘要】 研究背景：心房纤颤(房颤)是临床最常见的心律失常之一。尽管房颤的经导管射频消融治疗近几年不断成熟和发展,但射频消融治疗的患者仍有一部分会出现房颤复发,持续性房颤复发率较高。寻找能够预测持续性房颤射频消融术后复发的指标,对临床工作有重要指导意义。研究目的探讨持续性房颤患者体表心电图F波振幅预测射频消融术后房颤复发价值。研究方法回顾性研究2006年11月至2012年2月于北京协和医院心内科行经导管射频消融术的持续性房颤患者,收集临床资料,分析术前Ⅰ导联、aVF导联、V1导联中房颤波振幅。随访了解上述患者射频消融术后房颤复发情况。分析F波振幅与射频消融术后房颤复发的关系。结果1、50例患者中Ⅰ导联F波平均振幅0.057±0.012(0.033-0.091)mv,aVF导联的F波平均振幅0.098±0.031(0.060-0.209)mv,V1导联F波平均振幅0.133±0.043(0.082-0.271)mv,总F波平均振幅0.096±0.025(0.058-0.185)mv。2、50例患者平均随访时间25.2±18.5(4-68)月,房颤复发24例,复发率48%。3、根据F波振幅大小分组比较房颤复发率以0.1mv为界经典粗细波分组：aVF导联细波组房颤复发率62.5%,粗波组房颤复发率22.2%,P=0.006；V1导联细波组房颤复发率75%,粗波组房颤复发率39.7%,P=0.032；F波振幅总平均值细波组房颤复发率60.1%,粗波组房颤复发率23.5%,P=0.013；Ⅰ导联细波组与粗波组房颤复发率无统计学差异。以中位数为界粗细波分组：aVF导联F波振幅中位数0.093mv,细波组(<0.093mv)房颤复发率72%,粗波组(>0.093mv)房颤复发率24%,P=0.002；V1导联F波振幅中位数0.123mv,细波组(<0.123mv)房颤复发率64%,粗波组(>0.123mv)房颤复发率32%,P=0.024；F波振幅总平均值中位数0.089mv,细波组(<0.089mv)房颤复发率72%,粗波组(>0.089mv)房颤复发率24%,P=0.001；Ⅰ导联中位数0.054mv,细波组(<0.054mv)与粗波组(>0.054mv)房颤复发率无统计学差异。以四分位数为界粗细波分组：aVF导联四分位数为0.075、0.093、0.105mv(25%、50%、75%),细波组(<0.075mv)房颤复发率69.2%,粗波组(>0.105mv)房颤复发率15.4%,P=0.005；V1导联四分位数为0.101、0.123、0.152mv(25%、50%、75%),细波组(<0.101mv)房颤复发率69.2%,粗波组(>0.152mv)房颤复发率15.4%,P=0.005；F波振幅总平均值四分位数0.081、0.089、0.107mv(25%、50%、75%),细波组(<0.081mv)房颤复发率76.9%；粗波组(>0.107mv)房颤复发率23.1%,P=0.006；Ⅰ导联四分位数为0.047、0.054、0.064mv(25%、50%、75%),细波组(<0.047mv)与粗波组(>0.064mv)房颤复发率无统计学差异。4、F波振幅大小对房颤复发的预测能力aVF导联F波振幅以0.0934mv为最佳临界点,预测房颤复发敏感度73.1%,特异度75.0%；V1导联F波振幅以0.1248mv为最佳临界点,预测房颤复发敏感度65.4%,特异度70.8%；F波振幅总平均值以0.0895mv为最佳临界点,预测房颤复发敏感度73.1%,特异度75.0%。结论持续性房颤患者F波振幅大小与射频消融术后房颤复发相关,粗波房颤患者房颤复发率明显低于细波房颤患者。aVF导联、V1导联F波振幅对预测持续性房颤患者射频消融术后房颤复发有参考价值。更多还原

【Abstract】 BackgroundAtrial fibrillation (AF) is one of the most common clinical arrhythmia. Although radiofrequency catheter ablation for the treatment of atrial fibrillation in recent years continues to mature and develop, but some patients treated with radiofrequency ablation still recurred atrial fibrillation, persistent atrial fibrillation recurrence rate was high. Looking for indicators to predict the recurrence of persistent atrial fibrillation after radiofrequency ablation is important guiding significance for clinical work.ObjectivesInvestigate surface ECG F-wave amplitude of patients with persistent AF to predict atrial fibrillation recurrence ratio after radiofrequency ablation.MethodsRetrospective study patients with persistent atrial fibrillation who had taken radiofrequency catheter ablation at the Beijing Union Medical College Hospital Department of Cardiology,from November2006to February2012Collecte the information of clinical data, analysis the lead Ⅰ, lead aVF and lead V1F wave amplitude before radiofrequency catheter ablation. Follow-up these patients after radiofrequency ablation,and make sure if atrial fibrillation recurred. Analysis of the F wave amplitude and find the relationship between F wave amplitude and atrial fibrillation recurrence.ResultsF wave amplitude mean in lead I is0.057±0.012(0.033-0.091)mv. F wave amplitude mean in lead aVF is0.098±0.031(0.060-0.209)mv, F wave amplitude mean in lead V1is0.133±0.043(0.082-0.271)mv,the tatoal average of F wave amplitude0.096±0.025(0.058-0.185)mv50patients were followed up by25.2±18.5(4-68) months,24cases had atrial fibrillation recurrence, the recurrence ratio is48%.Compare the atrial fibrillation recurrence ratio between different F-wave amplitude size group:Divided by0.1mv:in lead aVF, the atrial fibrillation recurrence ratio of Fine AF group is62.5%, the atrial fibrillation recurrence ratio of Corase AF group is22.2%, P=0.006; in lead V1, the atrial fibrillation recurrence ratio of Fine AF group is75.0%, the atrial fibrillation recurrence ratio of Corase AF group is39.7%, P=0.032; in the total average F-wave amplitude group, the atrial fibrillation recurrence ratio of Fine AF group is60.1%, the atrial fibrillation recurrence ratio of Corase AF group is23.5%, P=0.013.Divided by the Median boundary:in lead aVF, the atrial fibrillation recurrence ratio of Fine AF group (<0.093mv)is72%, the atrial fibrillation recurrence ratio of Corase AF group (>0.093mv) is24%, P=0.002; in lead V1, the atrial fibrillation recurrence ratio of Fine AF group (<0.075mv) is64.0%, the atrial fibrillation recurrence ratio of Corase AF group is32%, P=0.024; in the total average F-wave amplitude group, the atrial fibrillation recurrence ratio of Fine AF group (<0.089mv) is72%, the atrial fibrillation recurrence ratio of Corase AF group (>0.089mv)is24%, P=0.001;in lead I there is no significant differences between the atrial fibrillation recurrence ratio of Fine AF group (<0.054mv) and Corase AF group(>0.054mv)Divided by the Quartile boundary:in lead aVF,0.075,0.093,0.105mv (25%,50%,75%), the atrial fibrillation recurrence ratio of Fine AF group is69.2%, the atrial fibrillation recurrence ratio of Corase AF group (>0.105mv) is15.4%, P=0.005; in lead V1,0.101,0.123,0.152mv (25%,50%,75%), the atrial fibrillation recurrence ratio of Fine AF group (<0.123mv) is64.0%, the atrial fibrillation recurrence ratio of Corase AF group is15.4%, P=0.005; in the total average F-wave amplitude group,0.081,0.089,0.107mv (25%,50%,75%), the atrial fibrillation recurrence ratio of Fine AF group (<0.081mv) is76.9%, the atrial fibrillation recurrence ratio of Corase AF group (>0.107mv)is23.1%, P=0.006; in lead I,0.047,0.054,0.064(25%,50%,75%), there is no significant differences between the atrial fibrillation recurrence ratio of Fine AF group (<0.047mv) and Corase AF group (0.064mv)F-wave amplitude as a indicator to predict the recurrence of atrial fibrillation:F-wave amplitude in lead aVF,choose cut-off point0.0934, to predict recurrence of atrial fibrillation sensitivity of73.1%, specificity75.0%; in lead V1, choose cut-off point0.1248to predict recurrence of atrial fibrillation sensitivity of65.4%, specificity70.8%; in the the total average group,choose cut-off point0.0895, to predict recurrence of atrial fibrillation sensitivity73.1%, specificity75.0%.ConclusionF-wave amplitude of the RF ablation in patients with persistent atrial fibrillation recurrence of atrial fibrillation, coarse wave of atrial fibrillation in patients with atrial fibrillation recurrence rate is significantly lower than the fine wave of patients with atrial fibrillation.F-wave amplitude in lead aVF, V1in patients with persistent atrial fibrillation after radiofrequency ablation in predicting recurrence of atrial fibrillation reference value.更多还原