Department of Cardiology, Toyama Prefectural Central Hospital, Toyama, Japan; Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
J Electrocardiol. 2023 Jul-Aug;79:30-34. doi: 10.1016/j.jelectrocard.2023.03.005. Epub 2023 Mar 11.
The prevalence of atrioventricular conduction disturbance (AVCD) in patients with persistent atrial fibrillation (AF) has not yet been fully investigated. We sought to identify the predictors of AVCD in patients with AF by analyzing the relationship between pre-ablation heart rate during AF and the PR interval in sinus rhythm after ablation. We analyzed pre-ablation 24-h Holter electrocardiogram (ECG) and 12 lead ECG 12 months after ablation of 121 consecutive patients with persistent AF who underwent their first ablation procedure and maintained sinus rhythm at 12 months. AVCD was defined as a first-degree atrioventricular block (AVB), second-degree AVB, high-degree AVB, or third-degree AVB observed on ECG at 12 months after ablation. Seventeen out of 121 patients (14.0%) had AVCD at 12 months. In the group with AVCD, total heartbeat (THB) and maximum heart rate (Max HR) were significantly lower, and the prevalence of concomitant Cavo-tricuspid isthmus-dependent atrial flutter before ablation and the appearance of macro reentrant atrial tachycardia (AT) during the procedure were significantly higher than those in the group without AVCD. Multiple regression analysis revealed that maximum HR and macro reentrant AT were significant predictors of AVCD. Receiver operating characteristic curve analysis revealed that Max HR of <165.0 bpm predicts AVCD with a sensitivity of 76.47% and a specificity of 74.00%. In patients with persistent AF, low Max HR and the presence of macro reentrant AT during the ablation procedure were predictors of AVCD.
持续性心房颤动（AF）患者房室传导障碍（AVCD）的发生率尚未完全研究。我们通过分析消融前 AF 期间的心率与消融后窦性节律时的 PR 间期之间的关系，旨在确定 AF 患者中 AVCD 的预测因子。我们分析了 121 例连续持续性 AF 患者的消融前 24 小时 Holter 心电图（ECG）和消融后 12 个月的 12 导联 ECG。这些患者均接受了首次消融治疗，且在 12 个月时维持窦性心律。AVCD 定义为消融后 12 个月时心电图上观察到的一度房室传导阻滞（AVB）、二度 AVB、高度 AVB 或三度 AVB。121 例患者中有 17 例（14.0%）在 12 个月时出现 AVCD。在 AVCD 组中，总心跳（THB）和最大心率（Max HR）明显较低，且消融前存在房室结折返性心动过速（AVNRT）和术中出现大折返性房性心动过速（AT）的发生率明显高于无 AVCD 组。多变量回归分析显示，最大 HR 和大折返性 AT 是 AVCD 的显著预测因子。受试者工作特征曲线分析显示，Max HR<165.0 bpm 预测 AVCD 的敏感性为 76.47%，特异性为 74.00%。在持续性 AF 患者中，低 Max HR 和消融过程中存在大折返性 AT 是 AVCD 的预测因子。
