房颤患者立体心电图P环特点与射频消融术后复发的关系.PDF

Med J Chin PLA, Vol. 38, No. 10, October 1, 2013 　847 论　著 房颤患者立体心电图P环特点与射频消融术后复发的关系 马君，马长生，李学文 [摘要]　目的　应用立体心电图(3D-ECG)分析房颤患者心房传导时间、传导方向及振幅的变化与房颤射频消融 术后复发的关系。方法　纳入2009年12月－2010年3月在北京安贞医院确诊房颤并进行射频消融术的患者42例。分别 在患者射频消融术术前及术后采集窦性心律3D-ECG并同步获取12导联心电图，分析每位患者射频消融术前、术后心 房传导时间，P环除极方向及振幅与射频消融术术后复发的关系。查阅入选患者病历资料获取此次射频消融术术前心 脏超声心动图左房内径数值及患者病史年限等资料，分析该组数据与房颤发生和射频消融术后复发的关系。结果　 术后P环方位对房颤复发具有明显影响(P =0.027) ，P环方位异常者房颤复发风险是P环方位正常者的8.4倍；左房大小 对房颤复发的影响亦有统计学意义(P =0.022) ；P环运行时间差对房颤复发的影响位于检验水准附近(P =0.058) 。病史 年限每增加1年，射频消融术后房颤复发的风险增加1.363倍。相关分析显示，右房直径与术后P环最大振幅呈正相关 (P=0.044) ，随右房直径增加，术后P环最大振幅呈增大趋势。结论　随着病史时间延长，心房传导时间延长，心房除 极方位及振幅发生变化，房颤患者的心房发生电重构和结构重构，二者共同作用导致了房颤的发生与维持。 [关键词]　心房颤动；导管消融术；电重构；结构重构 [中图分类号]　R541.7　　　[文献标志码]　A　　　[文章编号]　0577-7402(2013)10-0847-04 [DOI]　10.11855/j.issn.0577-7402.2013.10.014 Relationship between three-dimensional electrocardiographic P ring features and atrial fibrillation (AF) recurrence after radiofrequency ablation in AF patients MA Jun 1,2 2 3 , MA Chang-sheng , LI Xue-wen 1Department of Cardiology, Beijing A nzhen Hospital Affiliated to Capital Medical University, Beijing 100029, China 2ICU of Mentougou District Hospital, Beijing 102300, China 3Department of Cardiology, Shanxi Large Hospital, Taiyuan 030001, China [Abstract]　Objective　To explore the relation of the conduction time, conduction direction and amplitude of three- dimensional electrocardiogram (3D-ECG) to the recurrence after radiofrequency ablation in atrial fibrillation (AF) patients. M ethods　Forty-two patients diagnosed with AF and receiving radiofrequency ablation in Beijing Anzhen Hospital from December 2009 to March 2010 participated in the present study. 3D-ECG and synchronous 12-lead ECG of sinus rhythm was recorded before and after radiofreque