Wu Jin-Tao, Zhao Dan-Qing, Li Fei-Fei, Wu Rui, Fan Xian-Wei, Hu Guang-Ling, Bai Min-Fu, Yang Hai-Tao, Yan Li-Jie, Liu Jing-Jing, Xu Xian-Jing, Wang Shan-Ling, Chu Ying-Jie
Department of Cardiology, Henan Provincial People's Hospital, Henan Provincial People's Hospital of Henan University, Zhengzhou University People's Hospital, Central China Fuwai Hospital, Zhengzhou, China.
Department of Internal Medicine, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Clin Cardiol. 2019 Sep;42(9):806-811. doi: 10.1002/clc.23222. Epub 2019 Jun 26.
Paroxysmal atrial fibrillation (AF) frequently occurs in patients with Wolff-Parkinson-White (WPW) syndrome. Although successful ablation of the accessory pathway (AP) eliminates paroxysmal AF in some patients, in other patients it can recur.
We investigated the clinical utility of advanced interatrial block (IAB) for predicting the risk of AF recurrence in patients with verified paroxysmal AF and WPW syndrome after successful AP ablation.
This retrospective study included 103 patients (70 men, 33 women; mean age, 44 ± 16 years) with WPW syndrome who had paroxysmal AF. A resting 12-lead electrocardiogram was performed immediately after successful AP ablation to evaluate the presence of advanced IAB, which was defined as a P-wave duration of >120 ms and biphasic [±] morphology in the inferior leads.
During the mean follow-up period of 30.9 ± 20.0 months (range, 2-71 months), 16 patients (15.5%) developed AF recurrence. Patients with advanced IAB had significantly reduced event-free survival from AF (P < .001). Cox regression analysis with adjustment for the left atrial diameter and CHA DS -VASc score identified advanced IAB (hazard ratio, 9.18; 95% confidence interval [CI], 2.30-36.72; P = .002) and age > 50 years (hazard ratio, 12.64; 95% CI, 1.33-119.75; P = .027) as independent predictors of AF recurrence.
Advanced IAB was an independent predictor of AF recurrence after successful AP ablation in patients with WPW syndrome.
阵发性心房颤动（AF）在预激综合征（WPW）患者中频繁发生。虽然成功消融旁路（AP）可使部分患者的阵发性AF消失，但在其他患者中仍可能复发。
我们研究了高级心房阻滞（IAB）对预测已证实的阵发性AF和WPW综合征患者成功消融AP后AF复发风险的临床实用性。
这项回顾性研究纳入了103例患有阵发性AF的WPW综合征患者（70例男性，33例女性；平均年龄44±16岁）。成功消融AP后立即进行静息12导联心电图检查，以评估是否存在高级IAB，其定义为P波时限>120 ms且下壁导联呈双相[±]形态。
在平均30.9±20.0个月（范围2 - 71个月）的随访期内，16例患者（15.5%）发生AF复发。存在高级IAB的患者AF无事件生存期显著缩短（P<0.001）。经左心房直径和CHA₂DS - VASc评分校正的Cox回归分析确定，高级IAB（风险比，9.18；95%置信区间[CI]，2.30 - 36.72；P = 0.002）和年龄>50岁（风险比，12.64；95% CI，1.33 - 119.75；P = 0.027）是AF复发的独立预测因素。
高级IAB是WPW综合征患者成功消融AP后AF复发的独立预测因素。
