心电图f波振幅预测老年持续性心房颤动患者射频消融术后1年复发的价值

Predictive value of electrocardiogram f-wave amplitude for 1-year recurrence after radiofrequency ablation in elderly patients with persistent atrial fibrillation

摘要

目的: 探索心电图f波振幅在预测老年持续性心房颤动并行射频消融术的患者术后1年复发方面的价值。方法: 纳入2014年9月—2022年5月在南京医科大学第一附属医院明确诊断为持续性心房颤动并接受射频消融术的60岁及以上患者。根据患者术后1年是否复发分为未复发组与复发组，分析两组患者临床特征，将具有明显差异的指标纳入Logistic回归分析。结果: 共纳入369例，其中未复发组281例（76.15%），复发组88例（23.85%）。两组在年龄、体重指数、合并症、左心室舒张末期内径、左心室射血分数、肺动脉压力、脑钠肽前体、尿酸、低密度脂蛋白胆固醇、抗心律失常药物使用上无明显差异（P均>0.05）。与未复发组比较，复发组的女性比例高（39.77% vs. 26.69%， P=0.019），病程长[15.5（6.00，51.00）个月 vs. 9.00（3.00，24.00）个月， P<0.001]，Ⅲ导联[0.07（0.06，0.08）mV vs. 0.09（0.08，0.11）mV， P<0.001]、avF导联[0.06（0.05，0.07）mV vs. 0.08（0.07，0.10）mV， P<0.001]、V2导联[0.07（0.06，0.09）mV vs. 0.10（0.08，0.12）mV， P<0.001]f波振幅低，左心房内径[43.00（40.25，46.00）mm vs. 42.00（40.00，45.00）mm， P=0.039]、右心房内径[41.00（39.00，43.75）mm vs. 40.00（39.00，42.00）mm， P=0.038]更大。Logistic回归分析显示，心房颤动病程长是老年持续性心房颤动患者射频消融术后1年复发的危险因素，而avF导联、V2导联f波振幅高则与复发负相关。结论: 心电图f波振幅及病程可预测老年持续性心房颤动患者射频消融手术效果。

Abstract

Objective: To analyze the value of electrocardiogram（ECG）f-wave amplitude in predicting 1-year recurrence after radiofrequency catheter ablation（RFCA）in elderly patients with persistent atrial fibrillation（PsAF）. Methods: Patients aged ≥60 years who were diagnosed with PsAF and underwent RFCA in the First Affiliated Hospital of Nanjing Medical University from September 2014 to May 2022 were enrolled. Based on 1-year follow-up，patients were divided into two groups：the recurrence group and the non-recurrence group. The clinical characteristics of both groups were analyzed，and indicators showing significant differences were further examined using logistic regression analysis. Results: A total of 369 patients were included，among which there were 281 cases（76.15%）in the non-recurrence group and 88 cases（23.85%）in the recurrence group. There were no significant differences between the two groups in terms of age，body mass index，comorbidities，left ventricular end diastolic dimension，left ventricular ejection fraction，pulmonary artery pressure，Pro-BNP，uric acid，and low-density lipoprotein cholesterol，antiarrhythmic drugs（all P > 0.05）. Compared with the non-recurrence group，the recurrence group had higher female ratio（39.77% vs. 26.69%， P=0.019），a longer duration of atrial fibrillation[15.5（6.00，51.00）months vs. 9.00（3.00，24.00）months， P<0.001]，lower f-wave amplitude in lead Ⅲ[0.07（0.06，0.08）mV vs. 0.09（0.08，0.11）mV， P<0.001]，lead avF[0.06（0.05，0.07）mV vs. 0.08（0.07，0.10）mV， P<0.001]，and lead V2[0.07（0.06，0.09）mV vs. 0.10（0.08，0.12）mV， P<0.001]，larger LAD[43.00（40.25，46.00）mm vs. 42.00（40.00，45.00）mm， P=0.039]and RAD[41.00（39.00，43.75）mm vs. 40.00（39.00，42.00）mm， P=0.038]. Logistic regression analysis identified atrial fibrillation duration as a risk factor for recurrence in elderly patients，while f-wave amplitudes in lead V2 and avF were independently negatively correlated with 1-year recurrence after radiofrequency ablation. Conclusion: The ECG f-wave amplitudes and atrial fibrillation duration may serve as predictors of the outcome of RFCA in elderly patients with PsAF.

关键词

持续性心房颤动 / 射频消融术 / 老年 / 复发 / 心电图

Key words

persistent atrial fibrillation / radiofrequency ablation / elderly / recurrence / electrocardiogram

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基金资助

江苏省卫健委面上项目(X20241658)