Budeus Marco, Felix Oliver, Hennersdorf Marcus, Wieneke Heinrich, Erbel Raimund, Sack Stefan
Department of Cardiology, West-German Heart Centre, University of Duisburg-Essen, Essen, Germany.
Pacing Clin Electrophysiol. 2007 Feb;30(2):243-52. doi: 10.1111/j.1540-8159.2007.00656.x.
Paroxysmal atrial fibrillation (PAF) transits to permanent atrial fibrillation (PEAF). The current study was to determine whether a P wave-triggered P wave signal averaged electrocardiogram (P-SAECG) and chemoreflexsensitivity (CHRS) are useful to predict a conversion to PEAF in patients with PAF.
The filtered P wave duration (FPD) and the root mean square voltage of the last 20 ms of the P wave (RMS 20) were measured by P-SAECG. The ratio between the difference of RR intervals in the ECG and venous pO2 before and after 5-minutes oxygen inhalation is measured (ms/mmHg) for the determination of CHRS.
A total of 180 patients with PAF were enrolled and followed for a mean of 22.5 months. PEAF occurred in 38 patients (21%) and these patients had a significantly larger left atrial size (43.2 +/- 4.9 vs. 41.0 +/- 5.4 mm, P = 0.021), a significantly longer FPD (158.8 +/- 18.2 vs. 136.7 +/- 16.6 ms, P < 0.0001), and a significantly lower CHRS (1.96 +/- 0.99 vs. 2.44 +/- 1.19 ms/mmHg, P = 0.024) than patients with PAF. Patients with PEAF tended to have a lower RMS 20 (2.38 +/- 0.65 vs. 2.75 +/- 1.18 microV, P = 0.067) than patients with PAF. The chi(2) test showed that the combination of FPD > or = 145 ms, RMS 20 < or = 3.0 microV, left atrial size > or = 41 mm, and CHRS < or = 2.0 ms/mmHg had the best predictive power for PEAF. Patients who fulfilled these criteria had a 12-fold increased risk for a conversion from PAF to PEAF.
Our results show that a P-SAECG, an analysis of CHRS, and left atrial enlargement are clinical predictors of a progression from PAF to PEAF.
阵发性心房颤动（PAF）会转变为永久性心房颤动（PEAF）。本研究旨在确定P波触发的P波信号平均心电图（P-SAECG）和化学反射敏感性（CHRS）是否有助于预测PAF患者转变为PEAF。
通过P-SAECG测量滤波后的P波持续时间（FPD）和P波最后20毫秒的均方根电压（RMS 20）。测量心电图中RR间期差值与5分钟吸氧前后静脉血氧分压的比值（毫秒/毫米汞柱）以确定CHRS。
共纳入180例PAF患者，平均随访22.5个月。38例患者（21%）发生了PEAF，这些患者的左心房尺寸显著更大（43.2±4.9对41.0±5.4毫米，P = 0.021），FPD显著更长（158.8±18.2对136.7±16.6毫秒，P < 0.0001），且CHRS显著更低（1.96±0.99对2.44±1.19毫秒/毫米汞柱，P = 0.024）。与PAF患者相比，PEAF患者的RMS 20往往更低（2.38±0.65对2.75±1.18微伏，P = 0.067）。卡方检验表明，FPD≥145毫秒、RMS 20≤3.0微伏、左心房尺寸≥41毫米和CHRS≤2.0毫秒/毫米汞柱的组合对PEAF具有最佳预测能力。符合这些标准的患者从PAF转变为PEAF的风险增加了12倍。
我们的结果表明，P-SAECG、CHRS分析和左心房扩大是PAF进展为PEAF的临床预测指标。
