Budeus Marco, Hennersdorf Marcus, Wieneke Heinrich, Sack Stefan, Erbel Raimund, Perings Christian
Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Germany.
Int J Cardiol. 2005 Apr 20;100(2):317-24. doi: 10.1016/j.ijcard.2004.12.001.
Detailed analysis of the QRS-complex and autonomic dysfunction can identify patients at risk to suffer from ventricular arrhythmias. To determine whether patients at risk for paroxysmal atrial fibrillation (PAF) could be identified while in sinus rhythm, a P wave triggered signal averaged ECG and an analysis of the autonomic function by chemoreflexsensitivity (CHRS) were examined. The ratio between the difference of RR intervals in the ECG and the venous partial pressure of oxygen before and after 5-min oxygen inhalation was measured for the determination of CHRS. We examined 224 patients (group A) who suffered from PAF, 250 patients (group B) without arrhythmic history and 30 young volunteers (group C). The filtered P wave duration (FPD) was significantly longer in group A than in group B (140.9+/-21.0 vs. 118.2+/-9.4 ms, p<0.0001) or C (105.2+/-14.1 ms, p<0.0001) while the root mean square voltage of the last 20 ms of the P wave (RMS 20) was significantly lower in group A than in group B (2.68+/-1.12 vs. 4.06+/-1.57 microV, p<0.0001) or C (3.97+/-1.36 microV, p<0.0001). Atrial late potentials (ALP) were defined as a FPD>120 ms and a RMS 20< or =3.5 microV. ALP could identify patients of group A with a specificity of 78% and a sensitivity of 83%. Patients with PAF (2.32+/-1.15 ms/mm Hg) showed a significantly lower CHRS than group B (4.14+/-1.58 ms/mm Hg, p<0.0001) or group C (4.98+/-1.51 ms/mm Hg, p<0.0001). The sensitivity for the presence of atrial fibrillation was 71% for a CHRS below 3.0 ms/mm Hg with a specificity of 70%. A combination of both methods showed a specificity of 85% and a sensitivity of 65% when ALP and pathological CHRS were present. The results of our study suggest that risk of atrial fibrillation could be detected by P wave signal averaged ECG and CHRS. An analysis of CHRS seems to be an appropriate method to demonstrate a neurovegetative imbalance, which might be one possible trigger mechanism.
对QRS复合波和自主神经功能障碍进行详细分析，可以识别有发生室性心律失常风险的患者。为了确定在窦性心律时能否识别出阵发性心房颤动（PAF）风险患者，我们检查了P波触发信号平均心电图以及通过化学反射敏感性（CHRS）对自主神经功能进行的分析。通过测量心电图中RR间期的差值与5分钟吸氧前后静脉血氧分压之间的比值来测定CHRS。我们检查了224例PAF患者（A组）、250例无心律失常病史的患者（B组）和30名年轻志愿者（C组）。A组的滤波P波持续时间（FPD）显著长于B组（140.9±21.0 vs. 118.2±9.4毫秒，p<0.0001）或C组（105.2±14.1毫秒，p<0.0001），而A组P波最后20毫秒的均方根电压（RMS 20）显著低于B组（2.68±1.12 vs. 4.06±1.57微伏，p<0.0001）或C组（3.97±1.36微伏，p<0.0001）。心房晚电位（ALP）定义为FPD>120毫秒且RMS 20≤3.5微伏。ALP能够识别A组患者，特异性为78%，敏感性为83%。PAF患者（2.32±1.15毫秒/毫米汞柱）的CHRS显著低于B组（4.14±1.58毫秒/毫米汞柱，p<0.0001）或C组（4.98±1.51毫秒/毫米汞柱，p<0.0001）。CHRS低于3.0毫秒/毫米汞柱时，检测心房颤动存在的敏感性为71%，特异性为70%。当同时存在ALP和病理性CHRS时，两种方法联合使用的特异性为85%，敏感性为65%。我们的研究结果表明，通过P波信号平均心电图和CHRS可以检测出心房颤动风险。对CHRS的分析似乎是一种证明神经植物性失衡的合适方法，这可能是一种可能的触发机制。
