Liu Hailei, Gu Zhoushan, Zhu Chao, Li Mingfang, Jiao Jincheng, Chen Hongwu, Yang Gang, Ju Weizhu, Gu Kai, Zhang Fengxiang, Chen Lin Yee, Yang Di, Chen Minglong
Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States.
Front Cardiovasc Med. 2021 Nov 12;8:739350. doi: 10.3389/fcvm.2021.739350. eCollection 2021.
New-onset atrial fibrillation (AF) after ablation of typical atrial flutter (AFL) is not rare. This study aimed to investigate the predictive value of electrocardiographic parameters on new-onset AF post-typical AFL ablation. A total of 158 consecutive patients (79.1% males, mean age 57.8 ± 14.3 years) with typical AFL were enrolled between January 2012 and August 2017 in this single-center study. Patients with a history of AF before ablation were excluded. ECGs during sinus rhythm (SR) and AFL were collected. The duration of the negative component of flutter wave in lead II (D), proportion of the D of the total circle length of AFL (D%), amplitude of the negative component of flutter wave in lead II (A), duration (D), and amplitude (A) of negative component of the P wave in lead V1, and P wave duration in lead II (D) during sinus rhythm were measured. During a median follow-up of 26.9 ± 11.8 months, 22 cases (13.9%) developed new-onset AF. D was significantly longer in patients with new-onset AF compared to patients without AF (114.7 ± 29.6 ms vs. 82.7 ± 12.8 ms, < 0.0001). A was significantly lower (0.118 ± 0.034 mV vs. 0.168 ± 0.051 mV, < 0.0001), D (144.21 ± 23.77 ms vs. 111.46 ± 14.19 ms, < 0.0001), and D was significantly longer (81.07 ± 16.87 ms vs. 59.86 ± 14.42 ms, < 0.0001) in patients with new-onset AF. In the multivariate analysis, D [odds ratio (OR), 1.428; 95% CI, 1.039-1.962; = 0.028] and D (OR, 1.429; 95% CI, 1.046-1.953; = 0.025) were found to be independently associated with new-onset AF after typical AFL ablation. Parameters representing left atrial activation time under both the SR and AFL were independently associated with new-onset AF post-typical AFL ablation and may be useful in risk prediction, which needs to be confirmed by further prospective studies.
典型心房扑动（AFL）消融术后新发心房颤动（AF）并不罕见。本研究旨在探讨心电图参数对典型AFL消融术后新发AF的预测价值。在2012年1月至2017年8月期间，本单中心研究连续纳入了158例典型AFL患者（男性占79.1%，平均年龄57.8±14.3岁）。排除消融术前有AF病史的患者。收集窦性心律（SR）和AFL期间的心电图。测量II导联扑动波负向成分的持续时间（D）、D占AFL总周长的比例（D%）、II导联扑动波负向成分的振幅（A）、V1导联P波负向成分的持续时间（D）和振幅（A）以及窦性心律时II导联P波的持续时间（D）。在中位随访26.9±11.8个月期间，22例（13.9%）患者出现新发AF。与未发生AF的患者相比，新发AF患者的D明显更长（114.7±29.6毫秒对82.7±12.8毫秒，<0.0001）。A明显更低（0.118±0.034毫伏对0.168±0.051毫伏，<0.0001），新发AF患者的D（144.21±23.77毫秒对111.46±14.19毫秒，<0.0001）和D明显更长（81.07±16.87毫秒对59.86±14.42毫秒，<0.0001）。在多变量分析中，发现D[比值比（OR），1.428；95%置信区间，1.039 - 1.962；P = 0.028]和D（OR，1.429；95%置信区间，1.046 - 1.953；P = 0.025）与典型AFL消融术后新发AF独立相关。代表SR和AFL下左心房激活时间的参数与典型AFL消融术后新发AF独立相关，可能有助于风险预测，这需要进一步的前瞻性研究予以证实。
