【作者】 周丽娟；

【导师】 侯月梅；

【作者基本信息】 新疆医科大学 ， 内科学， 2009， 硕士

【摘要】 目的:探讨体表心电图P波变化:最大P波时限(Pmax)与P波离散度(Pd)对阵发性房颤经导管射频消融术后复发的预测价值。方法:本研究入选初次行导管射频消融术的阵发性房颤患者共43例,并收集相关临床资料、采用环肺静脉消融术,术前及术后当天行体表心电图检查、并测量P波最大时限及P波离散度、行电话与术后心电图、动态心电图随访6-14个月。结果:43例行射频消融术的患者中早期复发房性心律失常22例(51.16%),其中房颤20例。晚期复发房性心律失常15例(34.88%),心房纤颤(32.56%),1例为心房扑动(2.3%)。多因素回归分析提示最大P波时程是房颤早期复发的独立预测因素;而对于晚期房颤复发除最大P波时程外,P波离散度亦发现与房颤复发有相关性。以Pmax≥110ms作为预测指标,术后早期复发预测的敏感性77%、特异性为38%,晚期复发预测的敏感性为86.77%、特异性位38.1%。以Pmax≥120ms作为预测指标,早期复发预测的敏感性59.1%、特异性为85.71%,晚期敏感性66.67%、特异性为75%。以Pd≥40ms为预测指标晚期复发预测的敏感性为86.67%、特异性为17.86%。以Pmax≥120ms且Pd≥40ms为预测晚期复发指标敏感性、特异性分别为53.33%、21.42%。同时对术前及术后心电图对比,发现术后与术前P波无明显变化。结论:阵发性房颤经环肺静脉射频消融术后患者,P波最大时限是早晚期复发的独立预测因素,P波离散度于复发晚期亦有预测价值。Pmax≥120在早期复发中有较好的预测价值,其阳性预测值及阴性预测值分别为82.4%、69.2%;Pmax≥110ms在晚期复发中有较高的预测价值其阳性预测值及阴性预测值分别68.4%、85.7%。Pmax与Pd联合预测复发的敏感性及特异性不高,预测价值不大。术前术后Pmax与Pd比较未发现统计学差异。更多还原

【Abstract】 Objective: To determine the simple eletrocardiographic marker about maximal P wave duration(Pmax)and P dispersion(Pd) for the prediction of early or late recurrence after circumferential pulmonary vein ablation (CPVA)by lasso with paroxysmal atrial fibrillation(AF). Methods: The patients with paroxysmal atrial fibrillation after CPVA entered this study .Pulmonary vein isolation(PVI) was achieved via CPVA guided by CARTO system. Measuring the maximum P wave duration(Pmax), the minimum P wave (P mix ) and Pwave disperision (Pmax-Pmin) after the same day of CPVA. Systematic follow up was conductde after ablation,univariable and multivariable ananlysis were carried out to determinate the relationship between p wave changes and early or late recurrence of AF. Results: 22 cases (51.16%)showed atrial arrhythmias, including 20 cases (46.51%). 15cases (34.88%) showed late recurrence ,all of them are AF. Multivariate analysis showed that maximal P wave duration was the independent predictor for early recurrence. However , P dispersion and maximal P wave duration were the independent predictors for late recurrence .Prdictive value of P max and Pdis were evaluated using Pmax≥110ms or Pmax≥120ms Pd≥40ms as criteria.In early recurrence ,using Pmax≥110ms the sensitivity is 77 %and specificity is 38%,while when using Pmax≥120ms as criteria ,the sensitivity is 59.1 % and specificity is 85.71%, In late recurrence, using Pmax≥110ms the sensitivity is 86.77 %and specificity is 38.1%, using Pmax≥120ms as criteria ,the sensitivity is 66.67 % and specificity is 75%. Using Pd≥40ms as criteria , the sensitivity is 86.67 % and specificity is 17.86%, when using Pmax≥120ms and Pd≥40ms , the sensitivity is 53.33 % and specificity is 21.42%.Conclusion: For paroxysmal atrial fibrillation patients, maximal P wave duration is the independent predictor for early and late recurrence,and P dispersion is the independent predictior of late recurrence. Using Pmax≥120ms to predict the early recurrence has higher positive predictive value and negative predictive value than Pmax≥110ms . But in late recurrence, Pmax≥110ms has more value than Pmax≥120ms. The P waves were not changes before and after circumferential pulmonary vein ablation.更多还原