房颤体表心电图的信号处理及临床应用

【作者】 朱文佳；

【导师】 方全；

【作者基本信息】 北京协和医学院 ， 临床医学， 2013， 博士

【摘要】 背景房颤是临床最常见的心律失常之一。经导管射频消融术是目前房颤复律治疗的一个重要手段。但射频手术术后房颤复发率高达20-40%,虽然已知一些复发相关因素,但目前我们尚无法准确地预测复发。房颤频率作为心房电重塑的量化指标之一,对于预测射频术后是否复发以及筛选适合手术人群具有重要意义。现在我们可以通过无创的信号处理技术从体表心电图获得这一参数。目的以独立分量分析为基础,构建房颤信号处理的方法,并研究体表心电图房颤频率与患者临床参数及术后复发的关系。方法回顾性研究2012年3月至2013年3月于北京协和医院心内科行经导管射频消融术的房颤患者,收集临床资料,分别计算术前体表心电图及房内电极房颤频率。随访了解上述患者射频消融术后6个月时房颤复发情况。分析体表心电图与房内电极房颤频率的关系,并研究房颤频率与患者临床参数、射频消融术后房颤复发的关系。结果实验共入组房颤患者37人(28人为男性,年龄60±10岁),阵发性房颤10人(27.0%),持续性房颤27人(73.0%),体表心电图房颤频率6.36±1.17Hz(4-8.4Hz)。完成6个月随诊23人(18人为男性,年龄58±10岁),其中阵发性房颤9人(39.1%),体表心电图房颤频率6.20±1.15Hz(4.1-8.4Hz),复发7人(30.4%)。1、体表心电图与房内电极房颤频率呈高度线性相关(r=0.953,P<0.001)。2、体表心电图房颤频率与患者年龄(e=0.459,p=0.006)、房颤类型(p=0.002)、左室舒张末内径(r=-0.345,p=0.042)、合并高血压相关(p=0.027)3、根据roc曲线,选择6.45Hz为界将患者分为AFF高组与低组,判断射频消融术后6个月房颤复发敏感性达到85.7%,特异性达到68.7%。结论1、独立分量分析技术可用于房颤的信号处理。2、体表心电图房颤频率与患者的临床特点相关,包括年龄、性别、房颤类型等。3、体表心电图房颤频率与射频消融术后复发情况相关,可用于筛选适合手术人群。房颤频率高的患者,术后复发率更高。更多还原

【Abstract】 BackgroundAtrial fibrillation (AF) is one of the most common clinical arrhythmia. Radiofrequency catheter ablation plays an important role in the treatment of AF, but the recurrence reaches up to20-40percent. Although there’re several clinical variables related to the recurrence, we cann’t predict it precisely. As one of the quantitative indicators of atrial remodeling, atrial fibrilatory frequency(AFF) can be used to predict ablation outcome and help with patient selection for catheter ablation.ObjectivesGet AFF through signal processing of surface ECG of AF patients based on Independent Component Analysis (ICA). Investigate the relations between surface ECG AFF and clinical variables. Evaluate the role of surface ECG AFF to predict clinical outcomes of catheter ablation in patients with atrial fibrillation.MethodsRetrospective study patients with atrial fibrillation who had taken radiofrequency catheter ablation at the Beijing Union Medical College Hospital Department of Cardiology, from March2012to March2013. The clinical information of these patients, including patient history, ECG data and echocardiography date, were collected. The AFF of surface ECG and endocardial electrograms before radiofrequency catheter ablation were assessed respectively and analyzed with respect to clinical variables and catheter ablation outcome.ResultsCatheter ablation was performed in36patients (27men, aging60±10years), including10(27.8%) paroxysmal atrial fibrillation and26(72.2%) persistent atrial fibrillation. The surface ECG AFF is6.36±1.17Hz (4-8.4Hz).23patients accomplished6-months follow up(18men, aging58 ±10years), including9(39.1%) paroxysmal atrial fibrillation and14(60.9%)persistent atrial fibrillation.7(30.4%) patients had AF recurrence. The AFF of surface ECG and endocardial electrograms are highly linearly related (r=0.953, P<0.001). The surface ECG AFF was related to age (r=-0.459,P=0.006), type of AF(P=0.002), LVDD(r=-0.345, P=0.042), hypertension (p=0.027),. According to ROC curve, AFF was divided into2groups by6.45Hz.It could be used to predict recurrence6months after catheter ablation, with sensitivity85.7%and specificity68.7%.ConclusionICA is a reliable method in signal processing of atrial fibrillation. AFF is related to clinical features, such as age, gender and type of AF. AFF is related to recurrence after catheter ablation. The higher is AFF, the higher is recurrence rate. It could help with patient selection for catheter ablation.更多还原