体表心电图f波振幅对射频消融治疗持续性心房颤动疗效的评价

发布时间：2018-11-06 11:46

【摘要】：目的心房颤动(atrial fibrillation,简称房颤)是快速性房性心律失常之中最常见的类型。房颤患者的发病率随着中国乃至全球老龄化人群的增长呈现上升走势,当前国内外研究资料显示,房颤俨然已成为了一个重大的公共卫生问题,尤其是持续性房颤(persistent atrial fibrillation,PeAF)严重影响到人们的生活质量。尽管射频消融术(radiofrequency catheter ablation,RFCA)能有效治疗阵发性房颤,但是,目前RFCA治疗PeAF的疗效却不尽如人意,其术后复发率高。本论文对在我院完成RFCA治疗的PeAF患者的术前体表心电图(electrocardiogram,ECG))f波振幅进行分析,评价其对RFCA治疗PeAF的疗效。方法连续选取2014年9月至2016年9月间就诊于山东大学附属千佛山医院,首次接受RFCA治疗的非瓣膜病持续性房颤患者31例。收集PeAF患者RFCA术前的一般临床资料(例如:性别、年龄、房颤持续时间以及左房内径等),测量PeAF患者术前体表心电图Ⅱ、AVF以及V1导联的f波振幅,并对完成RFCA的房颤患者进行随访,根据术后是否复发将患者分为两组:复发组(11例)以及未复发组(20例),分析PeAF患者RFCA术前相关临床指标对RFCA术后复发的影响,计算预测PeAF患者RFCA术后复发的临床指标的ROC曲线下面积,预测指标的界值,特异度及灵敏度。结果与PeAF患者RFCA术后复发组相比,未复发组术前体表心电图AVF导联f波平均振幅[(0.087±0.012)mVvs.(0.117±0.024)mV,P=0.001]以及 V1导联f波平均振幅[(0.091±0.018)mVvs.(0.130±0.025)mV,P0.001]较前者高,并且,未复发组房颤平均持续时间[(28.36± 16.05)月vs.(16.35±12.61)月,P0.05]较前者短,差异均有统计学意义。Pearson相关性分析显示:房颤平均持续时间与PeAF患者RFCA术前体表心电图AVF导联f波平均振幅呈线性负相关(r=-0.371,P=0.040),而且,与V1导联f波平均振幅呈线性负相关(r=-0.394,P=0.028),PeAF患者RFCA术前体表心电图AVF导联f波平均振幅以及V,导联平均振幅呈线性正相关(r=0.444,P=0.012)。多因素Logistic回归分析显示:房颤平均持续时间[P=0.048,OR=1.086,OR 95%C.I.(1.001,1.178)]以及 PeAF 患者RFCA术前体表心电图V,导联f波平均振幅[P = 0.040,OR = 0.270,OR 95%C.I.(0.078,0.940)]是预测RFCA术后复发的危险因素。ROC曲线显示:房颤平均持续时间预测PeAF患者RFCA术后复发的ROC曲线下面积为0.736(P=0.032),其预测RFCA术后复发的界值、特异度及敏感度分别为13.5个月,60%,81.8%。V,导联f波平均振幅预测PeAF患者RFCA术后复发的ROC曲线下面积为0.898(P0.001),其预测术后复发的界值、特异度及敏感度分别为0.095mV,95%,72.7%。结论RFCA术前房颤持续时间以及术前体表心电图V,导联f波振幅可作为预测PeAF患者术后复发的预测指标,具有一定的临床参考价值。PeAF患者RFCA术前V1导联f波振幅低、房颤持续时间长的患者,RFCA术后更易复发。
[Abstract]:Objective Atrial fibrillation (atrial fibrillation,) is the most common type of atrial tachyarrhythmia. The incidence of atrial fibrillation (AF) patients is increasing with the increase of aging population in China and even the whole world. Current research data at home and abroad show that AF has become a major public health problem, especially persistent atrial fibrillation (persistent atrial fibrillation,). PeAF seriously affects people's quality of life. Although radiofrequency ablation (radiofrequency catheter ablation,RFCA) can effectively treat paroxysmal atrial fibrillation, the efficacy of RFCA in the treatment of PeAF is not satisfactory, and its recurrence rate is high. In this paper, we analyzed the amplitude of electrocardiogram,ECG) f wave in PeAF patients who completed RFCA treatment in our hospital, and evaluated the effect of RFCA on PeAF. Methods from September 2014 to September 2016, 31 patients with persistent atrial fibrillation who were treated with RFCA for the first time at Qianfushan Hospital affiliated to Shandong University were selected. To collect general clinical data (such as gender, age, duration of atrial fibrillation and left atrial diameter, etc.) before RFCA in patients with PeAF, and to measure the amplitude of F-wave of electrocardiogram 鈪，

本文编号：2314170