论文部分内容阅读
目的探讨体表心电图P波形态与阵发性心房颤动(PAF)的关系。方法选择52例非瓣膜性阵发性房颤患者及47例无PAF的对照组患者,测定窦性心律时12导联心电图P波离散度(Pd),最大P波时限(Pmax),V1导联P波终末电势(PtfV1)及aVR导联P波面积和振幅,超声心动图测定左房内径(LAD)、左室舒张末期内径(LVD)和左室射血分数(LVEF),分析PAF的敏感性、特异性、阳性预测值、准确度。结果与无PAF组相比,PAF组Pd和Pmax均显著增加,aVR导联负向P波振幅,P波面积及PtfV1则显著低于对照组。Pmax>100ms预测PAF的敏感性76.92%,特异性68.08%;Pd≥40ms预测PAF的敏感性80.77%,特异性78.72%;PtfV1≤-0.03mm.s预测PAF的敏感性67.31%,特异性61.70%;aVR导联P波面积预测PAF的准确性69.70%,P波振幅预测PAF的准确性67.68%。LAD增大(>40mm)者,仅aVR导联预测PAF的准确性无下降。结论对心房无显著增大患者,Pmax和Pd预测PAF较准确;对心房显著增大患者,aVR导联P波面积和振幅预测PAF的准确性较好。
Objective To explore the relationship between P wave morphology and paroxysmal atrial fibrillation (PAF). Methods 52 patients with non-valvular paroxysmal atrial fibrillation and 47 patients without PAF were enrolled in this study. The 12-lead electrocardiogram P wave dispersion (Pd), maximum P wave time (Pmax), V1 P wave area and amplitude of the terminal P wave potentials (PtfV1) and aVR leads were measured. Left atrium diameter (LAD), left ventricular end diastolic dimension (LVD) and left ventricular ejection fraction (LVEF) were measured by echocardiography. PAF Sensitivity, specificity, positive predictive value, accuracy. Results Compared with non-PAF group, the Pd and Pmax in PAF group were significantly increased. The amplitude of negative P wave, P wave area and PtfV1 in aVR lead were significantly lower than those in control group. Pmax> 100ms predicts PAF sensitivity 76.92% and specificity 68.08%; Pd≥40ms predicts PAF sensitivity 80.77% and specificity 78.72%; PtfV1≤-0.03mm.s predicts PAF sensitivity 67.31% and specificity 61.70 %. The accuracy of P wave area estimation of aVR leads to 69.70% of the accuracy of PAF, P wave amplitude predicts the accuracy of PAF of 67.68%. With an increase in LAD (> 40 mm), only the aVR lead predicted no improvement in the accuracy of PAF. Conclusion In patients with no significant increase in atrium, Pmax and Pd predict PAF more accurately. For patients with atrial enlargement significantly, P wave area and amplitude of aVR lead predict the accuracy of PAF.