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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2016, Vol. 04 ›› Issue (04) : 202 -206. doi: 10.3877/cma.j.issn.2095-5782.2016.04.004

所属专题： 文献；

心脏介入

心率减速力联合体表心电图V1导联f波振幅对心房颤动射频消融术后复发的预测价值
宋玮1, 闫文菊1, 张焕轶1, 郭忠秀1, 周发展1,†()   
  1. 1. 山东泰安，泰安市中心医院心内科
  • 收稿日期:2016-10-02 出版日期:2016-11-01
  • 通信作者: 周发展
  • 基金资助:
    山东省自然科学基金项目(ZR2015HL005)

Predictive value of deceleration capacity of heart rate combined with fibrillatory wave amplitude on lead V1 of surface electrocardiography in atrial fibrillation patients with recurrence after radiofrequency catheter ablation

Wei Song1, Wenju Yan1, Huanyi Zhang1, Zhongxiu Guo1, Fazhan Zhou1,†()   

  1. 1. Department of Cardiology, Taian City Center Hospital, Taian 271000, China
  • Received:2016-10-02 Published:2016-11-01
  • Corresponding author: Fazhan Zhou
  • About author:
    Corresponding author: Zhou Fazhan,Email:
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宋玮, 闫文菊, 张焕轶, 郭忠秀, 周发展. 心率减速力联合体表心电图V1导联f波振幅对心房颤动射频消融术后复发的预测价值[J]. 中华介入放射学电子杂志, 2016, 04(04): 202-206.

Wei Song, Wenju Yan, Huanyi Zhang, Zhongxiu Guo, Fazhan Zhou. Predictive value of deceleration capacity of heart rate combined with fibrillatory wave amplitude on lead V1 of surface electrocardiography in atrial fibrillation patients with recurrence after radiofrequency catheter ablation[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2016, 04(04): 202-206.

目的：

探讨心率减速力（DC）联合体表心电图V1导联f波平均振幅对心房颤动（AF）患者射频消融术后复发的预测价值。

方法：

选取2015年6月—2016年6月因AF在我院住院并行首次射频消融术的患者56例，根据术后随访结果分为未复发组36例，复发组20例。统计两组患者一般资料、DC值及体表心电图V1导联f波平均振幅并进行比较，建立Logistic回归模型，筛选AF患者射频消融术后复发的危险因素，分别对DC值、体表心电图V1导联f波平均振幅及二者联合进行受试者工作特征（ROC曲线）绘制，评价二者联合对AF术后复发的预测价值。

结果：

复发组患者DC值（5.89±1.00）ms高于未复发组（4.88±0.99）ms、体表心电图V1导联f波平均振幅（0.094±0.014）mV小于未复发组（0.109±0.018）mV，差异均有统计学意义；术后DC较术前明显下降；经多因素Logistic回归分析显示，DC值大、体表心电图V1导联f波平均振幅小是AF患者射频消融术后复发的独立危险因素；DC值、体表心电图V1导联f波平均振幅预测AF术后复发的ROC曲线下面积分别为0.764、0.748，二者比较无统计学差异（P=0.86）,二者联合预测AF术后复发曲线下面积为0.837，高于各自值（P<0.05）。

结论

DC联合体表心电图V1导联f波平均振幅对心房颤动射频消融术后复发具有预测价值。

关键词: 心率减速力, f波振幅, 心房颤动, 射频消融, 复发
Objective:

To explore the predictive value of deceleration capacity of heart rate(DC) combined with fibrillatory wave amplitude on lead V1 of surface electrocardiography in atrial fibrillation (AF) patients with recurrence after radiofrequency catheter ablation.

Methods:

56 AF patients who underwent radio frequency catheter ablation for the first time from June 2015 to June 2016 were selected for this study. According to the follow-up results, these patients were divided into the non-recurrent group (n=36) and the recurrent group (n=20). Their basic information, DC values, fibrillatory wave amplitude on lead V1 of surface electrocardiography were collected and compared to establish a Logistic regression model, based on which, the risk factors for AF patients after radiofrequency catheter ablation were screened. DC values, fibrillatory wave amplitude on lead V1 of surface electrocardiography and the combination of the two methods were depicted into Receiver operating curve (ROC), and to evaluate the predictive value of the combination of the two methods on the recurrence of the AF patients who underwent radio frequency catheter ablation.

Results:

The DC value in the recurrence group (5.89±1.00) was higher than that in the non recurrence group(4.88±0.99). The fibrillatory wave amplitude on lead V1 of surface electrocardiography in the recurrence group (0.094±0.014 mV) was less than that in the non recurrence group(0.109±0.018 mV) (all P<0.05). Postoperative DC was significantly decreased compared with the preoperative value. Multivariate Logistic regression analysis showed that the DC value、fibrillatory wave amplitude on lead V1 of surface electrocardiography are independent risk factors for recurrence after radiofrequency ablation in AF patients. The ROC curves of DC and mean amplitude showed AUC were 0.764 and 0.748(P=0.86). The ROC curves of combination of the two methods showed AUC was 0.837, higher than their respective values (P < 0.05).

Conclusions:

Deceleration capacity of heart rate(DC) combined with fibrillatory wave amplitude on lead V1 of surface electrocardiography has a predictive value in atrial fibrillation(AF) patients who likely will have recurrence after radiofrequency catheter ablation.

Key words: Deceleration capacity of heart rate, Fibrillatory wave amplitude, Atrial fibrillation, Catheter radiofrequency ablation, Recurrence
表1 未复发组与复发组基本资料比较
组别 例数 年龄（岁） 男性（%） BMI（kg/ m2） 合并高血压 合并冠心病 LA（mm） LVEF
未复发组 36 57.28±10.04 21（58.3） 24.56±1.66 10（27.78） 17(47.2) 38.03±3.34 0.601±0.059
复发组 20 56.75±9.58 11（55.0） 26.25±1.76 14（70.00） 7（35.0） 40.45±4.22 0.606±0.076
统计量 ? t=0.19 χ2=0.06 t=3.61 χ2=9.36 χ2=0.78 t=2.36 t=0.28
P值 ? 0.850 1 0.001 0.002 0.380 0.022 0.781
组别 例数 胆固醇（mmol/L） 低密度脂蛋白胆固醇（mmol/L） 同型半胱氨酸（μmol/L） 病程（月） 持续性房颤 f波平均振幅（mV）
未复发组 36 4.93±0.85 2.52±0.55 10.89±2.56 9.86±5.09 21（58.33） 0.109±0.018
复发组 20 4.90±0.63 2.57±0.68 11.69±3.78 12.00±4.14 6（30.00） 0.094±0.014
统计量 ? t=0.14 t=0.34 t=0.94 t=2.83 χ2=4.13 t=2.31
P值 ? 0.891 0.734 0.352 0.014 0.042 0.001
表2 手术前后未复发组与复发组DC值比较
组别 例数 术前DC（ms） 术后DC（ms） t值 P值
未复发组 36 4.88±0.99 4.28±0.66 6.35 <0.001
复发组 20 5.89±1.00 5.13±0.87 8.17 <0.001
t值 ? 3.31 4.51 ? ?
P值 ? 0.001 <0.001 ? ?
表3 房颤术后复发因素的Logistic回归分析结果
变量 单因素 多因素
OR值(95%CI) P值 OR值(95%CI) P值
BMI 1.76(1.22～2.54) 0.002 2.032(1.108～3.728) 0.022
合并高血压 6.07(1.82～20.20) 0.003 19.377(1.594～235.485) 0.020
LA 1.20(1.02～1.41) 0.029 0.871(0.646～1.176) 0.368
持续性房颤 3.27(1.02～10.46) 0.046 24.572(1.903～317.212) 0.014
DC 2.77(1.44～5.36) 0.002 2.953(1.075～8.112) 0.036
f波平均振幅 <0.01(<0.01～<0.01) 0.004 0.01(<0.01～0.01) 0.010
图1 DC及体表心电图V1导联f波平均振幅预测AF术后复发的ROC曲线
1
籍振国,刘志红,马国平,等.心房颤动的流行病学现状及危害[J].医学与哲学:临床决策论坛版,2009,30(3):10-12.
2
Scherlag BJ, Nakagawa H, Jackman WM, et al. Electrical stimulation to identify neural elements on the heart: their role in atrial fibrillation[J]. J Interv Card Electrophysiol, 2005, 13(Suppl 1):37-42.
3
Wei W,Ge JB,Zou Y,et al. Anatomical characteristics of pulmonary veins for the prediction of postoperative recurrence after radiofrequency catheter ablation of atrial fibrillation[J]. PLoS One,2014,9(4):e93817. doi: 10.1371/journal.pone.0093817.
4
Kalil C, Bartholomay E, Borges A,et al. Atrial fibrillation ablation by use of electroanatomical mapping: efficacy and recurrence factors[J]. Arq Bras Cardiol,2014,102(1):30-38. doi: 10.5935/abc.20130211.
5
Bauer A，Kantelhardt JW，Barthel P，et al. Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction:cohort study[J]. Lancet，2006，367(9523):1674-1681.
6
Scherlag BJ, Yamanashi WS, Schauerte P, et al. Endovascular stimulation within the left pulmonary artery to induce slowing of heart rate and paroxysmal atrial fibrillation[J].Cardiovasc Res,2002,54(2):470-475.
7
Pappone C, Santinelli V, Manguso F, et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation[J]. Circulation, 2004, 109(3):327-334.
8
郭继鸿.猝死预警新技术:连续心率减速力测定[J].临床心电学杂志，2012，21(3):227-233. doi:10.3969/j.issn.1005-0272.2012.03.028.
9
Cheng Z, Deng H, Cheng K, et al.The amplitude of fibrillatory waves on leads aVF and V1 predicting the recurrence of persistent atrial fibrillation patients who underwent catheter ablation[J].Ann Noninvasive Electrocardiol, 2013, 18(4):352-358. doi: 10.1111/anec.12041.
10
余敏.F波振幅对持续性房颤射频消融术后复发预测价值研究[D].北京协和医学院，2012.
11
Roithinger FX, SippensGroenewegen A, Karch MR, et al.Organized activation during atrial fibrillation in man :endocardial and electrocadiographic manifestations[J].J Cardiovasc Electrophysiol, 1998, 9(5):451-461.
12
Ashikaga K, Kobayashi T, Kimura M, et al. Effects of amiodarone on electrical and structural remodeling induced in a canine rapid pacing-induced persistent atrial fibrillation model[J]. Eur J Pharmacol, 2006, 536(1-2):148-153.
13
Goudis CA, Kallergis EM, Vardas PE. Extracellular matrix alterations in the atria: insights into the mechanisms and perpetuation of atrial fibrillation[J]. Europace, 2012, 14(5):623-630. doi: 10.1093/europace/eur398.
14
Eckstein J, Verheule S, de Groot NM, et al. Mechanisms of perpetuation of atrial fibrillation in chronically dilated atria[J]. Prog Biophys Mol Biol, 2008, 97(2-3):435-451. doi: 10.1016/j.pbiomolbio.2008.02.019.
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