An Kang, Li Haojie, Yu Chunyu, Zheng Zhe
Department of Cardiovascular Surgery, National Center for Cardiovascular Disease, Beijing, China.
Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Interdiscip Cardiovasc Thorac Surg. 2024 May 2;38(5). doi: 10.1093/icvts/ivae057.
To investigate the predictive values of surface electrocardiogram-derived parameters in patients with atrial fibrillation who underwent thoracoscopic epicardial ablation.
The present study included 102 patients with atrial fibrillation who underwent thoracoscopic epicardial ablation and whose baseline 12-lead electrocardiograms were available. Frequency domain analysis was performed to calculate the electrocardiogram-derived parameters. Cox proportional hazards regression was used to identify predictive risk factors for postoperative recurrence.
At 36-month interval, the overall rate of freedom from atrial tachyarrhythmia without antiarrhythmic drugs was 58.5%. The results of the univariable and multivariable analyses showed that larger left atrial diameter (hazard ratio: 1.074, 95% confidence interval: 1.021-1.130, P = 0.006) was an independent risk factor for atrial fibrillation recurrence, while higher fibrillatory wave amplitude was a protective factor (hazard ratio: 0.292, 95% confidence interval: 0.157-0.542, P < 0.001). The associations were clarified by the restricted cubic splines. The dominant frequency and organization index were not identified as statistically significant parameters.
The fibrillatory wave amplitude has the highest predictive value for atrial fibrillation recurrence in electrocardiogram-derived parameters. Together with left atrial diameter, it may help identify patients in whom thoracoscopic ablation is likely to be effective.
探讨体表心电图衍生参数对接受胸腔镜心外膜消融术的房颤患者的预测价值。
本研究纳入102例接受胸腔镜心外膜消融术且有基线12导联心电图的房颤患者。进行频域分析以计算心电图衍生参数。采用Cox比例风险回归分析确定术后复发的预测风险因素。
在36个月的随访期内，未使用抗心律失常药物时无房性快速性心律失常的总体发生率为58.5%。单因素和多因素分析结果显示，较大的左心房直径（风险比：1.074，95%置信区间：1.021-1.130，P = 0.006）是房颤复发的独立危险因素，而较高的颤动波振幅是保护因素（风险比：0.292，95%置信区间：0.157-0.542，P < 0.001）。通过限制性立方样条曲线明确了两者之间的关联。优势频率和组织指数未被确定为具有统计学意义的参数。
在心电图衍生参数中，颤动波振幅对房颤复发具有最高的预测价值。与左心房直径一起，它可能有助于识别胸腔镜消融术可能有效的患者。
