2024 年第 10 期 第 19 卷

24小时动态心电图对预激综合征伴心房颤动患者射频消融术后心房颤动复发的预测价值

The predictive value of 24-hour dynamic electrocardiogram for the recurrence of atrial fibrillation after radiofrequency ablation in patients with pre-excitation syndrome and atrial fibrillation

作者：蔡玲1成瑶1张磊2

英文作者：Cai Ling1 Cheng Yao1 Zhang Lei2

单位：1新疆维吾尔自治区喀什地区第一人民医院心电功能科，喀什844000；2新疆医科大学第四附属医院心血管内科，乌鲁木齐830054

英文单位：1Department of Electrocardiogram Function the First People′s Hospital of Kashgar Xinjiang Uygur Autonomous Region Kashgar 844000 China; 2Department of Cardiovascular the Fourth Affiliated Hospital of Xinjiang Medical University Urumqi 830054 China

关键词：心房颤动；预激综合征；24h动态心电图；射频消融术；复发

英文关键词：Atrialfibrillation;Pre-excitationsyndrome;24hdynamicelectrocardiogram;Radiofrequencyablation;Recurrence

• 摘要：

• 目的 探讨24 h动态心电图对预激综合征（WPW）伴心房颤动患者射频消融术后心房颤动复发的预测价值。方法 选取2021年8月至2023年9月在新疆维吾尔自治区喀什地区第一人民医院心电功能科就诊的WPW伴心房颤动射频消融术后6个月心房颤动复发的患者51例（复发组）及51例术后未复发心房颤动患者（未复发组）。比较2组患者术前24 h动态心电图［P波振幅、最大P波时限（Pmax）、P波离散度（Pd）和P波终末电势（Ptf）、PR间期、心率校正后QT间期（QTc）和Tp-Te间期］。采用多因素Logistic回归模型分析WPW伴心房颤动患者射频消融术后心房颤动复发的影响因素，并用受试者工作特征（ROC）曲线分析24 h动态心电图对术后心房颤动复发的预测价值。结果 复发组QTc、P波振幅、Pmax、Pd值高于未复发组，而Ptf则低于未复发组（均P＜0.05）。复发组年龄、病程、左心房直径、消融前心房颤动发作频率高于未复发组，左心室射血分数（LVEF）低于未复发组（均P＜0.05）。Logistic回归分析结果显示，年龄大、高Pmax和Pd值及低LVEF均是WPW伴心房颤动患者射频消融术后心房颤动复发的独立危险因素（均P＜0.05）。ROC曲线显示，Pmax、Pd单独预测WPW伴心房颤动患者射频消融术后心房颤动复发的曲线下面积（AUC）为0.809（95%置信区间：0.769～0.838）、0.811（95%置信区间：0.770～0.875），二者联合预测AUC为0.918（95%置信区间：0.878～0.949），联合预测效能较单独预测效能更好（均P＜0.05）。结论 24 h动态心电图参数与WPW伴心房颤动患者射频消融术后心房颤动复发有关，其中P波电位的Pmax和Pd值是WPW伴心房颤动患者射频消融术后心房颤动复发的危险因素，且二者联合预测术后心房颤动复发的效能较高。

• Objective To investigate the value of 24 h dynamic electrocardiogram in predicting the recurrence of atrial fibrillation in patients with pre-excitation syndrome (WPW) and atrial fibrillation after radiofrequency ablation. Methods Fifty-one WPW patients with atrial fibrillation recurrence 6 months after radiofrequency ablation (recurrence group) and 51 WPW patients without atrial fibrillation recurrence (non-recurrence group) were selected from August 2021 to September 2023 in the Department of Electrocardiogram Function, the First People′s Hospital of Kashgar, Xinjiang Uygur Autonomous Region. The 24 h dynamic electrocardiogram ［P wave amplitude, maximum P wave duration (Pmax), P wave dispersion (Pd) and P wave terminal potential (Ptf), PR interval, QT interval corrected for heart rate (QTc) and Tp-Te interval］ were compared between the two groups before operation.Multivariate Logistic regression model was used to analyze the influencing factors of atrial fibrillation recurrence after radiofrequency ablation in patients with WPW and atrial fibrillation. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of postoperative atrial fibrillation recurrence. Results The values of QTc, P wave amplitude, Pmax and Pd in recurrence group were higher than those in non-recurrence group, while Ptf was lower than that in non-recurrence group (all P＜0.05). The age, duration of disease, left atrial diameter and atrial fibrillation attack frequency before ablation in the recurrence group were higher than those in the non-recurrence group, and left ventricular ejection fraction (LVEF) was lower than that in the non-recurrence group (all P＜0.05). Logistic regression analysis showed that older age, high Pmax and Pd values, and low LVEF were independent risk factors for atrial fibrillation recurrence after radiofrequency ablation in WPW patients with atrial fibrillation (all P＜0.05). ROC curve showed that the areas under the curve(AUC) of Pmax and Pd alone to predict the recurrence of atrial fibrillation after radiofrequency ablation in WPW patients with atrial fibrillation were 0.809(95% confidence interval: 0.769-0.838) and 0.811(95% confidence interval: 0.770-0.875), the AUC of combined prediction was 0.918 (95% confidence interval: 0.878-0.949), and the combined prediction efficiency is better than the individual prediction efficiency (both P＜0.05). Conclusion The 24 h dynamic electrocardiogram is related to the recurrence of atrial fibrillation after radiofrequency ablation in patients with WPW and atrial fibrillation. The Pmax and Pd values of P-wave potential are the risk factors for recurrence of atrial fibrillation after radiofrequency ablation in patients with WPW and atrial fibrillation, and the combination of the two has high efficacy in predicting recurrence of atrial fibrillation after radiofrequency ablation.