CAJ | 학술논문

目的：射频导管消融( RFCA)是心房颤动(房颤)主要的治疗手段，然而关于RFCA术后房颤复发的预测指标较少。本研究探讨预测房颤首次RFCA术后复发的较为实用的心电学指标。方法对172例在2009年至2010年首次在大连医科大学附属第一医院二部行RFCA术的阵发性房颤患者进行随访研究。测量术前最大P波时限( P-max)、最小P波时限( P-min)、P波离散度( PWD)、PR间期及V1导联P波终末电势( PtfV1)，探讨PtfV1≥0．04 mV·s在预测首次行RFCA的阵发性房颤患者术后复发的价值。结果首次行RFCA患者分为复发组(57例)和未复发组(115例)。单因素分析显示心力衰竭、左心房内径、P-max、P-min、PtfV1≥0．04 mV·s与房颤复发显著相关，二元Logistic回归分析发现PtfV1≥0．04 mV·s是房颤复发的独立预测因素。 PtfV1≥0．04 mV·s与房颤的Kaplan-Meier曲线及ROC曲线均显示差异具有统计学意义。PtfV1≥0．04 mV·s对房颤复发预测的灵敏度为72．0%，特异度为73．9%。结论PtfV1≥0．04 mV·s能够很好地预测阵发性房颤首次RFCA术后复发，有一定的推广价值。
목적：사빈도관소융( RFCA)시심방전동(방전)주요적치료수단，연이관우RFCA술후방전복발적예측지표교소。본연구탐토예측방전수차RFCA술후복발적교위실용적심전학지표。방법대172례재2009년지2010년수차재대련의과대학부속제일의원이부행RFCA술적진발성방전환자진행수방연구。측량술전최대P파시한( P-max)、최소P파시한( P-min)、P파리산도( PWD)、PR간기급V1도련P파종말전세( PtfV1)，탐토PtfV1≥0．04 mV·s재예측수차행RFCA적진발성방전환자술후복발적개치。결과수차행RFCA환자분위복발조(57례)화미복발조(115례)。단인소분석현시심력쇠갈、좌심방내경、P-max、P-min、PtfV1≥0．04 mV·s여방전복발현저상관，이원Logistic회귀분석발현PtfV1≥0．04 mV·s시방전복발적독립예측인소。 PtfV1≥0．04 mV·s여방전적Kaplan-Meier곡선급ROC곡선균현시차이구유통계학의의。PtfV1≥0．04 mV·s대방전복발예측적령민도위72．0%，특이도위73．9%。결론PtfV1≥0．04 mV·s능구흔호지예측진발성방전수차RFCA술후복발，유일정적추엄개치。
Objective Radio frequency catheter ablation ( RFCA) is a main therapy for atrial fibrilla-tion ( AF) . However, the recurrence of AF after RFCA is a common clinical problem. This research focused on evaluating the predictive value of P-wave related electrocardiography parameters in primary recurrence of atrial fibrillation after RFCA. Methods One hundred and seventy-two patients between 2009 and 2010 who were reverted to sinus rhythm by RFCA were consecutively enrolled in this study. The predictive value of P-wave ter-minal vector of V1 lead ( PtfV1 )≥0. 04 mV·s in recurrence of RFCA was assessed after measurements of max-imum P-wave duration ( P-max) , minimum P-wave duration ( P-min) , P-wave dispersion ( PWD) , PR interval and PtfV1 before operation. Results There were two groups:recurrence group (57 patients) and no recurrence group (115 patients). Univariate analysis showed heart failure, left atrial diameter, P-max, P-min, PtfV1≥0. 04 mV·s were relevant to the recurrence of AF. PtfV1≥0. 04 mV·s was the independent predictive factor after binary logistic regression analyzing. The Kaplan-Meier curve of PtfV1≥0. 04 mV·s revealed satisfactory clinical value as well as ROC curve. The sensitivity and specificity of PtfV1≥0. 04 mV·s in predicting AF was 72. 0% and 73. 9%,respectively. Conclusion PtfV1≥0. 04 mV·s had a good predictive value in recurrence of paroxysmal atrial fibrillation after first RFCA. Taking many advantages into consideration, it is well worth popularized application.