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目的探讨P波离散度(Pd)对阵发房颤环肺静脉消融(CPVA)术远期预后的预测价值。方法顺序入选116例阵发性房颤患者行CPVA术至肺静脉电隔离。测量和计算算末次消融术前和术后P波最大值(Pmax),P波最小值(Pmin),P波离散度(Pd)。结果随访45.7±19.2个月,112例患者完成了研究,成功率达78.6%。根据随访结果,分为成功组和复发组。两组消融术前Pmax、Pmin和Pmax相似。成功组术后Pmax和Pd显著降低[Pmax(101.2±10.9)vs(.117.3±13.8)ms,p<0.01;Pd(34.8±6.7)vs.(49.3±10.3)ms,p<0.01],而复发组术后P波各参数均无明显变化。两组相比,成功组术后Pd和Pmax较复发组显著降低[Pmax(116.4±9.9)ms,Pd(49.2±8.8)ms]。COX回归分析显示两组左房内径和LVEF均无明显差异;术后Pd和Pmax是阵发房颤CPVA术后远期复发的独立预测因子。结论 Pmax和Pd反映了心房非均质性活动,术后Pmax和Pd可作为阵发房颤CPVA术后远期复发的预测因素。
Objective To investigate the predictive value of P wave dispersion (Pd) for long-term prognosis of paroxysmal atrial fibrillation pulmonary vein (CPVA). Methods One hundred and sixty - six patients with paroxysmal atrial fibrillation were enrolled in this study. Measurements and calculations were performed before and after the final ablation of P wave maximum (Pmin), P wave (Pmin), P wave dispersion (Pd). The results were followed up 45.7 ± 19.2 months, 112 patients completed the study, the success rate of 78.6%. According to follow-up results, divided into successful group and recurrent group. Pmax, Pmin and Pmax were similar in two groups before ablation. Pmax and Pd decreased significantly in the successful group (Pmax (101.2 ± 10.9) vs (.117.3 ± 13.8) ms, p <0.01, respectively; 34.8 ± 6.7 vs. 49.3 ± 10.3, p <0.01] There was no significant change in P wave parameters in recurrence group. Compared with the recurrent group, the Pmax (116.4 ± 9.9) ms and Pd (49.2 ± 8.8) ms, respectively) were significantly decreased in the successful group compared with the recurrent group. COX regression analysis showed no significant differences in LVEF and left ventricular diameter between the two groups; postoperative Pd and Pmax were independent predictors of long-term recurrence after paroxysmal atrial fibrillation (CPVA). Conclusions Pmax and Pd reflect atrial heterogeneity. Postoperative Pmax and Pd can be used as predictors of long-term recurrence of paroxysmal atrial fibrillation after CPVA.