摘要
目的本研究旨在应用组织多普勒技术获取心房电机械传导时间，评估其预测阵发性心房颤动（房颤）患者射频导管消融（RFCA）术后复发的价值。方法纳入2013年7月至2015年10月武汉大学人民医院心内科接受RFCA的阵发性房颤（PAF）患者144例（PAF组）和健康志愿者82例（对照组），所有研究对象窦性心律下接受超声心动图检查。常规超声心动图技术获取左心房容积指数以及左心室收缩功能和舒张功能指标。组织多普勒获取二尖瓣环间隔、侧壁和三尖瓣环3个位点电机械延迟时间（electromechanical delay time，EMD，自心电图P波起始至瓣环组织运动频谱a’波起始），上述时间差值分别为心房间电传导时间（interatrial conduction time，IACT）、右心房内电传导时间（intrafight atrial conduction time，IRCT）和左心房内电传导时间（intra—left atrial conduction time，ILCT）.RFCA术后随访观察1年以上，PAF组分为复发组（AFR组）和窦性心律维持组（SRR组）。比较各组上述指标的差异，探讨各指标预测房颤复发的价值。结果与对照组相比，PAF组IACT、ILCT和IRCT均大于对照组[（20．92±13．76）ms对（13．98±10．01）ms，P=0．004；（21．58±12．57）ms对（15．84±11．41）ms，P=0．015；（16．27±10．79）ms对（12．31±10．10））ms，P=0．044]，差异有统计学意义；左心房内径（LAD）、右心房内径（RAD）、左心房舒张末期容积（LAEDV）和左心房收缩末期容积（LAESV）均大于对照组（P〈0．05），差异有统计学意义；A峰和a’峰均小于对照组，差异有统计学意义（P〈0．05oAFR组IACT和ILCT明显高于SRR组，差异有统计学意义[（26．86±20．67）ms对（19．45±11．04）ms，P=0．047；（37．64±9．62）ms对（17．63±9．78）ms，P=0．0001]。ROC曲线分析ILCT预测房颤复发曲线下面积0．931，ILCT≥24．5ms时预测的敏感性和特异性分别为0．929和0．789。结论PAF患者心房电机械传导时间显著高于对照组，ILCT在PAFRFCA术后复发的预测中有一定价值。
Objective The aim of this study was to evaluate the value of atrial conduction time, measured by tissue Doppler echocardiography, for predicting atrial fibrillation （ AF ） recurrence after successful radio frequency catheter ablation （ RFCA ）. Methods One hundred and forty-four paroxysmal AF （ PAF ） patients were enrolled in the study, who accepted RFCA operation in Renmin Hospital of Wuhan University from July 2013 to October 2015. Eighty-two control subjects were also collected in the study and all subjects underwent echocardiographic examination under sinus rhythm. Left atrial volume index and left ventricular systolic and diastolic function indicators were measured by conventional echocardiography. Atrial electromechanical delay time （ EMD, measured from the onset of P wave to the onset of the beginning of a＇wave ） were detected by tissue Doppler image. EMD was calculated on lateral mitral annuli, septal mitral annuli and right ventricular tricuspid annuli. The differences between these intervals were defined as interatrial electromechanical conduction time （ IACT ）, intra-right atrial electromechanical conduction time （ IRCT ） and intra-left atrial electromechanical conduction time （ ILCT ）. Patients were divided into two groups AF recurrence （ AFR ） group and sinus rhythm recurrence （ SRR ） group during 12 months of follow-up. Results IACT, ILCT and IRCT were significantly higher in AFR group than in SRR group [ （ 20.92 ± 13.76 ） ms vs. （ 13.98 ±10.01 ） ms, P=0.004; （21.58 ± 12.57 ）ms vs. （ 15.84 ±11.41 ）ms, P=0.015; （ 16.27 ± 10.79 ）ms vs. （ 12.31 ± 10.10 ）ms, P=0.044 ）. Left atrial diameter （ LAD ）, right atrial diameter （ RAD ）, left atrial end-diastolic volume （ LAEDV ）, and left atrial end-systolic volume （ LAEDV ） were also significantly higher in AFR group than in SRR group （ all P〈0.05 ）. While A and a＇ were significantly lower in PAF group than in control group （ all P〈0.05 ）. IACT and ILCT were significantly higher in AFR group than in SRR group [ （ 26.86 ± 20.67 ） ms vs. （ 19.45 ±11.04 ） ms, P=0.047 ;（ 37.64 ±9.62 ） ms vs. （ 17.63 ±9.78 ） ms, P=0.000 1 ）. ILCT was an independent predictor of the AF recurrence after successful RFCA, in receiver operating characteristic curve analysis with AUC 0.931. When ILCT≥ 24.5 ms the sensitivity and specificity were 0.929 and 0.789, respectively. Conclusion Atrial electromechanical conduction time detected by tissue Doppler eehocardiography was significantly higher in PAF patients. ILCT is a useful predictor for atrial fibrillation recurrence independently.
作者
谭团团
包明威
胡波
张逸杰
郭瑞强
周青
Tan Tuantuan, Bao Mingwei, Hu Bo, Zhang Yifie, Guo Ruiqiang, Zhou Qing.(Department of Ultrasonography, Renmin Hospital of Wuhan University, Wuhan 430060, Chin)
出处
《中华心律失常学杂志》
2018年第1期54-59,共6页
Chinese Journal of Cardiac Arrhythmias
基金
中央高校基本科研项目（2042016kf0126）
关键词
心房颤动
复发
心房
电机械传导
Atrial fibrillation
Recurrence
Atrium
Electromechanical conduction
作者简介
通信作者：周青，Email：34222795@qq．com
