Altunkeser Bülent B, Ozdemir Kurtuluş, Gök Hasan, Temizhan Ahmet, Tokaç Mehmet, Karabağ Turgut
Department of Cardiology, Faculty of Medicine, Selçuk University, Konya, Turkey.
Angiology. 2003 Jul-Aug;54(4):475-9. doi: 10.1177/000331970305400412.
This study was planned to investigate the parameters detecting risk of developing atrial fibrillation (AF) in patients with sinus rhythm with structural heart disease. Forty-five patients with AF and 37 patients without AF but with structural heart disease (Group I) were included in this study. Thirty-eight patients (Group II) had successfully undergone medically or electrically cardioversion after transesophageal echocardiography. The restoration of sinus rhythm could not be achieved in 7 patients who were excluded from this study. After providing sinus rhythm, amiodarone was given orally to the patients to prevent recurrences. Left ventricular ejection fraction (LVEF) was calculated and left atrial diameter (LAD) was measured by echocardiography in group I and in group II after cardioversion. A 12-lead electrocardiography (ECG) was simultaneously obtained from all the patients. In these ECG recordings, maximum P wave duration (P max), minimum P wave duration (P min), and P wave dispersion (P dispersion) were calculated. P dispersion was expressed as "P max-P min." Also, the highest P wave voltage is expressed as P amplitude maximum (P amp max), the lowest P wave as P amplitude minimum (P amp min), and P amplitude dispersion (P amp dispersion) was calculated as the difference of both. In univariate analysis, P max, P dispersion, P amp max, P amp dispersion, LAD, LVEF, and old age were significant predictors of chronic AF (p < 0.001, p < 0.01, p < 0.01, p < 0.01, p = 0.003, p = 0.02, and p = 0.01, respectively). However, in multivariate analysis, P max and LAD were independent predictors of chronic AF in patients with structural heart disease (r = 0.39, p < 0.05; r = 0.34; p < 0.05, respectively). In conclusion, in estimating the risk of developing chronic AF, P max and LAD are predictive parameters in patients with sinus rhythm with structural heart disease.
本研究旨在调查检测患有结构性心脏病的窦性心律患者发生心房颤动（AF）风险的参数。本研究纳入了45例房颤患者和37例无房颤但患有结构性心脏病的患者（I组）。38例患者（II组）在经食管超声心动图检查后成功接受了药物或电复律。7例患者未能恢复窦性心律，被排除在本研究之外。恢复窦性心律后，给予患者口服胺碘酮以预防复发。I组和复律后的II组通过超声心动图计算左心室射血分数（LVEF）并测量左心房直径（LAD）。同时从所有患者获取12导联心电图（ECG）。在这些ECG记录中，计算最大P波时限（P max）、最小P波时限（P min）和P波离散度（P离散度）。P离散度表示为“P max - P min”。此外，最高P波电压表示为P波振幅最大值（P amp max），最低P波表示为P波振幅最小值（P amp min），P波振幅离散度（P amp离散度）计算为两者之差。在单因素分析中，P max、P离散度、P amp max、P amp离散度、LAD、LVEF和老年是慢性房颤的显著预测因素（分别为p < 0.001、p < 0.01、p < 0.01、p < 0.01、p = 0.003、p = 0.02和p = 0.01）。然而，在多因素分析中，P max和LAD是结构性心脏病患者慢性房颤的独立预测因素（分别为r = 0.39，p < 0.05；r = 0.34；p < 0.05）。总之，在评估发生慢性房颤的风险时，P max和LAD是患有结构性心脏病的窦性心律患者的预测参数。
