心电图P波离散度联合QTc间期预测阵发性房颤射频消融术后早期复发的效能

doi:10.3969/j.issn.1006-6233.2024.06.027

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摘要 目的: 探讨心电图P波离散度(Pd)联合QTc间期预测阵发性房颤(PAF)射频消融术后早期复发的效能。方法: 选取2019年1月至2023年6月PAF患者108例,均行射频消融术,术后随访3个月,根据是否复发分为复发组(28例)与未复发组(80例),比较两组基线资料、术前、术后7d Pd、QTc及术前与术后7d Pd、QTc差值(^△Pd、^△QTc),分析Pd、QTc对术后早期复发的影响及预测效能。结果: 复发组病程长于未复发组,高血压比例、CHA2DS2-VASc评分高于未复发组(P<0.05);复发组术前、术后7d Pd(32.68±5.75)ms、(26.27±7.13)ms大于未复发组(28.51±5.04)ms、(17.16±6.28)ms,QTc(458.27±52.31)ms、(410.65±30.52)ms长于复发组(430.19±39.62)ms、(372.06±25.40)ms(t=3.631、6.376、2.960、6.558,P均<0.001);复发组术前与术后7d ^△Pd(6.41±2.67)ms、^△QTc(47.62±10.33)ms小于未复发组(11.35±4.19)ms、(58.13±13.27)ms(t=5.828、3.803,P均<0.001);术前Pd、QTc与CHA2DS2-VASc评分呈正相关(P<0.05);在校正病程、高血压、CHA2DS2-VASc评分等其他因素前后,^△Pd、^△QTc均是PAF射频消融术后早期复发的独立影响因素(P<0.05);^△Pd预测PAF射频消融术后早期复发的AUC为0.779(95%CI:0.689~0.853),约登指数为0.473,敏感度为78.57%,特异度为68.75%;^△QTc预测PAF射频消融术后早期复发的AUC为0.715(95%CI:0.620~0.798),约登指数为0.411,敏感度为78.57%,特异度为62.50%;^△Pd、^△QTc联合预测PAF射频消融术后早期复发的AUC为0.940(95%CI:0.878~0.977),约登指数为0.779,敏感度为92.86%,特异度为85.00%,优于两者单独预测。结论: 心电图Pd与QTc间期在PAF患者射频消融术前后的变化值联合预测术后复发的效能较高,能为临床防治提供相关指导信息。

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关键词 ：阵发性房颤, 射频消融术, 早期复发, 心电图, P波离散度, QTc间期, 预测效能

Abstract：Objective: To investigate the efficacy of electrocardiogram (ECG) P-wave dispersion (Pd) combined with QTc interval in predicting early recurrence after radiofrequency ablation (RFA) for paroxysmal atrial fibrillation (PAF).Methods: A total of 108 PAF patients who underwent RFA from January 2019 to June 2023 were selected and followed up for 3 months after the operation. They were divided into a recurrence group (28 cases) and a non-recurrence group (80 cases) based on recurrence status. Baseline data, preoperative and postoperative 7-day Pd, QTc, and the differences (^△Pd, ^△QTc) between preoperative and postoperative 7-day Pd, QTc were compared between the two groups. The influence of Pd and QTc on early postoperative recurrence and their predictive efficacy were analyzed.Results: The disease course was longer, and the proportion of hypertension and CHA2DS2-VASc scores were higher in the recurrence group compared to the non-recurrence group (P<0.05). Preoperative and postoperative 7-day Pd (32.68±5.75) ms, (26.27±7.13) ms were higher than those in the non-recurrence group (28.51±5.04) ms, (17.16±6.28) ms, and QTc (458.27±52.31) ms, (410.65±30.52) ms were longer than those in the non-recurrence group (430.19±39.62) ms, (372.06±25.40) ms (t=3.631, 6.376, 2.960, 6.558, all P<0.001). Preoperative and postoperative 7-day ^△Pd (6.41±2.67) ms, ^△QTc (47.62±10.33) ms were lower in the recurrence group than in the non-recurrence group (11.35±4.19) ms, (58.13±13.27) ms (t=5.828, 3.803, all P<0.001). Preoperative Pd, QTc were positively correlated with CHA2DS2-VASc score (P<0.05). After adjusting for other factors such as disease course, hypertension, and CHA2DS2-VASc score, ^△Pd and ^△QTc remained independent influencing factors for early recurrence after PAF RFA (P<0.05). The AUC for ^△Pd in predicting early recurrence after PAF RFA was 0.779 (95% CI: 0.689-0.853), with a Youden index of 0.473, sensitivity of 78.57%, and specificity of 68.75%; for ^△QTc, the AUC was 0.715 (95% CI: 0.620-0.798), with a Youden index of 0.411, sensitivity of 78.57%, and specificity of 62.50%. The combined prediction of ^△Pd and ^△QTc for early recurrence after PAF RFA had an AUC of 0.940 (95% CI: 0.878-0.977), Youden index of 0.779, sensitivity of 92.86%, and specificity of 85.00%, which was superior to either predictor alone.Conclusion: The changes in ECG Pd and QTc interval before and after RFA in PAF patients have high efficacy in predicting postoperative recurrence and can provide relevant guidance for clinical prevention and treatment.

Key words： Paroxysmal atrial fibrillation Radiofrequency ablation Early recurrence Electrocardiogram P-wave dispersion QTc interval Predictive efficacy

基金资助:江苏省优势学科建设工程项目,(编号:YSHL1931-319)

通讯作者: 许铎

引用本文:

尹微, 刘文武, 许铎. 心电图P波离散度联合QTc间期预测阵发性房颤射频消融术后早期复发的效能[J]. 河北医学, 2024, 30(6): 1020-1025.
YIN Wei, et al. The Efficacy of ECG P-Wave Dispersion Combined with QTc Interval in Predicting Early Recurrence After Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. HeBei Med, 2024, 30(6): 1020-1025.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2024.06.027 或 http://www.hbyxzzs.cn/CN/Y2024/V30/I6/1020

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