Cardiovascular Department, Hôpital de La Tour, 1 av. J. D. Maillard, CH-1217, Meyrin, Geneva, Switzerland.
Europace. 2013 Feb;15(2):198-204. doi: 10.1093/europace/eus251. Epub 2012 Aug 31.
Recurrences of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA) are usually caused by pulmonary vein (PV) re-conduction, by foci outside the PV or by previous electrical remodelling. Substrate alterations with conduction delays may be detected by signal-averaged P-wave analysis (SAPW). This study was conducted to assess the value of the SAPW to predict recurrences after RFCA in patients with paroxysmal or persistent AF.
One hundred and two patients (59 ± 10 years, 83 males) underwent a first RFCA procedure for paroxysmal (n = 61) or persistent/long-standing persistent (n = 41) AF. A SAPW recording with measurement of total filtered P-wave duration (FPD), P-wave integral, and terminal root mean squared voltage was obtained immediately after the ablation procedure and the patients were prospectively followed. During a mean follow-up of 12 ± 7 months, recurrences occurred in 36 of 102 (35.3%) patients, 17 of 61 with paroxysmal AF, and 19 of 41 with persistent AF (P = 0.06). The FPD was significantly longer in patients with recurrences compared to those without (158 ± 22 vs. 140 ± 18 ms, P = 0.0008). The FPD was shorter in patients with paroxysmal AF compared with patients with persistent AF (142 ± 28 vs. 153 ± 20 ms, P = 0.03). A FPD of 140 ms was found to discriminate patients prone to recurrences (log-rank test, P = 0.008) with a sensitivity of 69%, a specificity of 53%, a positive predictive value of 45%, and a negative predictive value of 76%.
A FPD >140 ms is a marker of AF recurrences after RFCA and probably reflects the extent of atrial remodelling.
射频导管消融（RFCA）后心房颤动（AF）的复发通常是由肺静脉（PV）再传导、PV 外灶或先前的电重构引起的。信号平均 P 波分析（SAPW）可检测到具有传导延迟的基质改变。本研究旨在评估 SAPW 在预测阵发性或持续性 AF 患者 RFCA 后复发中的价值。
102 例患者（59 ± 10 岁，83 例男性）接受了第一次 RFCA 治疗阵发性（n = 61）或持续性/长程持续性（n = 41）AF。消融后立即进行 SAPW 记录，测量总滤波 P 波持续时间（FPD）、P 波积分和终末均方根电压，并对患者进行前瞻性随访。在平均 12 ± 7 个月的随访中，102 例患者中有 36 例（35.3%）发生复发，其中 61 例阵发性 AF 患者中有 17 例，41 例持续性 AF 患者中有 19 例（P = 0.06）。与未复发患者相比，复发患者的 FPD 明显较长（158 ± 22 与 140 ± 18 ms，P = 0.0008）。与持续性 AF 患者相比，阵发性 AF 患者的 FPD 较短（142 ± 28 与 153 ± 20 ms，P = 0.03）。发现 FPD 为 140 ms 可区分易复发患者（对数秩检验，P = 0.008），其敏感性为 69%，特异性为 53%，阳性预测值为 45%，阴性预测值为 76%。
FPD >140 ms 是 RFCA 后 AF 复发的标志物，可能反映了心房重构的程度。
