Kishima Hideyuki, Mine Takanao, Takahashi Satoshi, Ashida Kenki, Ishihara Masaharu, Masuyama Tohru
Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Japan.
Heart Vessels. 2016 Nov;31(11):1848-1854. doi: 10.1007/s00380-015-0789-3. Epub 2016 Jan 5.
The cause of prolonged filtered P-wave duration (FPD) remains unclear in atrial fibrillation (AF) patients with normal left atrial size. We investigated whether FPD is associated with left atrial pressure (LAP) in AF patients without prominent LA enlargement. This study included 80 patients (48 men, age 65 ± 9 years, 25 persistent AF) with non-valvular AF who underwent catheter ablation (CA) for AF. LAP was measured in sinus rhythm during CA and signal-averaged electrocardiogram was recorded after CA. We retrospectively assessed the clinical and echocardiographic variables. Prolonged FPD was defined as FPD > 120 ms. Prolonged FPD (FPD > 120 ms) was detected in 23/80 patients (29 %). According to univariate analysis, higher mean LAP (14.9 ± 4.4 vs. 10.8 ± 3.5 mmHg, p < 0.0001), higher prevalence of persistent arrhythmia, higher BNP, larger LAD, higher E wave, and lower LVEF were associated with Prolonged FPD. According to multivariate analysis, higher mean LAP was the only factor associated with Prolonged FPD (p = 0.0058, OR 1.256 for each 1 mmHg increase in mean LAP, 95 % CI 1.068-1.476). Moreover, a significant correlation was observed between FPD and mean LAP (r = 0.503, p < 0.0001). Prolonged FPD is associated with high LAP in AF patients without prominent left atrial enlargement. Pressure overload of the left atria might cause slowing of atrial electrical activation.
在左心房大小正常的心房颤动（AF）患者中，滤过P波时限（FPD）延长的原因仍不清楚。我们研究了在无明显左心房扩大的AF患者中，FPD是否与左心房压力（LAP）相关。本研究纳入了80例接受AF导管消融（CA）的非瓣膜性AF患者（48例男性，年龄65±9岁，25例持续性AF）。在CA期间窦性心律时测量LAP，并在CA后记录信号平均心电图。我们回顾性评估了临床和超声心动图变量。FPD延长定义为FPD>120 ms。80例患者中有23例（29%）检测到FPD延长（FPD>120 ms）。单因素分析显示，较高的平均LAP（14.9±4.4 vs. 10.8±3.5 mmHg，p<0.0001）、持续性心律失常的较高患病率、较高的脑钠肽（BNP）、较大的左心房内径（LAD）、较高的E波和较低的左心室射血分数（LVEF）与FPD延长相关。多因素分析显示，较高的平均LAP是与FPD延长相关的唯一因素（p = 0.0058，平均LAP每增加1 mmHg，OR为1.256，95%CI为1.068 - 1.476）。此外，FPD与平均LAP之间存在显著相关性（r = 0.503，p<0.0001）。在无明显左心房扩大的AF患者中，FPD延长与高LAP相关。左心房压力超负荷可能导致心房电活动减慢。
