Fujimoto Yuhi, Yodogawa Kenji, Takahashi Kenta, Tsuboi Ippei, Hayashi Hiroshi, Uetake Shunsuke, Iwasaki Yu-Ki, Hayashi Meiso, Miyauchi Yasushi, Shimizu Wataru
Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Heart Vessels. 2017 Nov;32(11):1375-1381. doi: 10.1007/s00380-017-1008-1. Epub 2017 Jun 19.
Atrial fibrillation (AF) itself creates structural and electrophysiological changes such as atrial enlargement, shortening of refractory period and decrease in conduction velocity, called "atrial remodeling", promoting its persistence. Although the remodeling process is considered to be reversible, it has not been elucidated in detail. The aim of this study was to assess the feasibility of P wave dispersion in the assessment of reverse atrial remodeling following catheter ablation of AF. Consecutive 126 patients (88 males, age 63.0 ± 10.4 years) who underwent catheter ablation for paroxysmal AF were investigated. P wave dispersion was calculated from the 12 lead ECG before, 1 day, 1 month, 3 months and 6 months after the procedure. Left atrial diameter (LAD), left atrial volume index (LAVI), left ventricular ejection fraction (LVEF), transmitral flow velocity waveform (E/A), and tissue Doppler (E/e') on echocardiography, plasma B-type natriuretic peptide (BNP) concentrations, serum creatinine, and estimated glomerular filtration rate (eGFR) were also measured. Of all patients, 103 subjects remained free of AF for 1 year follow-up. In these patients, P wave dispersion was not changed 1 day and 1 month after the procedure. However, it was significantly decreased at 3 and 6 months (50.1 ± 14.8 to 45.4 ± 14.4 ms, p < 0.05, 45.2 ± 9.9 ms, p < 0.05, respectively). Plasma BNP concentrations, LAD and LAVI were decreased (81.1 ± 103.8 to 44.8 ± 38.3 pg/mL, p < 0.05, 38.2 ± 5.7 to 35.9 ± 5.6 mm, p < 0.05, 33.3 ± 14.2 to 29.3 ± 12.3 mL/m, p < 0.05) at 6 months after the procedure. There were no significant changes in LVEF, E/A, E/e', serum creatinine, and eGFR during the follow up period. P wave dispersion was decreased at 3 and 6 months after catheter ablation in patients without recurrence of AF. P wave dispersion is useful for assessment of reverse remodeling after catheter ablation of AF.
心房颤动（AF）本身会引发结构和电生理变化，如心房扩大、不应期缩短和传导速度降低，即所谓的“心房重构”，这会促使房颤持续存在。尽管重构过程被认为是可逆的，但尚未得到详细阐明。本研究的目的是评估P波离散度在评估房颤导管消融术后心房逆向重构中的可行性。对连续126例接受阵发性房颤导管消融术的患者（88例男性，年龄63.0±10.4岁）进行了研究。在手术前、术后1天、1个月、3个月和6个月，根据12导联心电图计算P波离散度。还测量了超声心动图上的左心房直径（LAD）、左心房容积指数（LAVI）、左心室射血分数（LVEF）、二尖瓣血流速度波形（E/A）和组织多普勒（E/e'）、血浆B型利钠肽（BNP）浓度、血清肌酐和估算肾小球滤过率（eGFR）。在所有患者中，103例患者在1年随访期内未再发生房颤。在这些患者中，术后1天和1个月时P波离散度未发生变化。然而，在3个月和6个月时显著降低（分别从50.1±14.8降至45.4±14.4毫秒，p<0.05；45.2±9.9毫秒，p<0.05）。术后6个月时，血浆BNP浓度、LAD和LAVI降低（分别从81.1±103.8降至44.8±38.3皮克/毫升，p<0.05；38.2±5.7降至35.9±5.6毫米，p<0.05；33.3±14.2降至29.3±12.3毫升/米，p<0.05）。随访期间，LVEF、E/A、E/e'、血清肌酐和eGFR无显著变化。在未复发房颤的患者中，导管消融术后3个月和6个月时P波离散度降低。P波离散度有助于评估房颤导管消融术后的逆向重构。
