Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan.
Heart Rhythm. 2010 Mar;7(3):289-94. doi: 10.1016/j.hrthm.2009.11.012. Epub 2009 Nov 12.
Terminal P-wave inversion in lead V(1) representing left atrial overload has been considered a precursor of atrial fibrillation (AF).
The purpose of this study was to determine whether this P-wave morphologic characteristic can predict the development of AF.
Digital analysis of 12-lead ECGs was performed to enroll patients with P terminal force > or =0.06 s x 2 mm in lead V(1) from among a database of 308,391 ECG recordings. The prognostic value of ECG characteristics for developing AF was determined.
A total of 78 patients (mean age 52 +/- 19 years) with left atrial overload were chosen from among 102,065 patients in the database. During mean follow-up of 43 months, 15 (19%) patients developed AF (AF group) versus 63 (81%) patients who did not (non-AF group). No significant difference was noted between the AF and non-AF groups with regard to the area, duration, and amplitude of the P-wave terminal portion in lead V(1). In contrast, the area, duration, and amplitude of the P-wave initial portion in the same lead were significantly greater in the AF group than in the non-AF group (114.6 +/- 73.0 microV x ms vs 73.1 +/- 59.3 microV x ms, 42.2 +/- 12.4 ms vs 35.7 +/- 10.1 ms, and 94.0 +/- 39.9 microV vs 68.8 +/- 49.4 microV, respectively; P <.05 for each). Multivariate analysis confirmed that the area of the P-wave initial portion was independently associated with the development of AF (hazard ratio 4.02, 95% confidence interval 1.25-17.8; P = .018).
P-wave initial portion in lead V(1) was an independent risk stratifier of AF development in patients with marked left atrial overload.
V1 导联终末 P 波倒置代表左心房负荷过重，被认为是心房颤动（AF）的先兆。
本研究旨在确定这种 P 波形态特征是否可预测 AF 的发生。
对数据库中 308391 份心电图记录中的 V1 导联 P 终末力>或=0.06 s x 2 mm 的患者进行 12 导联心电图数字分析。确定心电图特征对发生 AF 的预测价值。
从数据库中的 102065 例患者中选择了 78 例（平均年龄 52±19 岁）左心房负荷过重的患者。平均随访 43 个月期间，15 例（19%）患者发生 AF（AF 组），63 例（81%）患者未发生 AF（非 AF 组）。AF 组与非 AF 组 V1 导联 P 波终末部分的面积、持续时间和振幅无显著差异。相反，同一导联 P 波初始部分的面积、持续时间和振幅在 AF 组显著大于非 AF 组（114.6±73.0μV×ms 比 73.1±59.3μV×ms，42.2±12.4ms 比 35.7±10.1ms，94.0±39.9μV 比 68.8±49.4μV；P<.05 均）。多变量分析证实 P 波初始部分的面积与 AF 的发生独立相关（危险比 4.02，95%置信区间 1.25-17.8；P=0.018）。
V1 导联 P 波初始部分是明显左心房负荷过重患者发生 AF 的独立危险分层指标。
