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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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

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

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