Ding Qiuju, Wang Zhigang, Lu Lichong, Song Zhizhao, Ge Min, Zhou Qing
Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Front Cardiovasc Med. 2024 Nov 8;11:1483591. doi: 10.3389/fcvm.2024.1483591. eCollection 2024.
Corrected QT interval (QTc) is a ventricular repolarization marker on electrocardiography. Previous studies evaluated its value in predicting atrial fibrillation (AF) occurrence. However, its predictive efficacy for AF recurrence remains controversial.
We searched PubMed and Google databases for studies before January 2024 evaluating the association between QTc interval and AF incidence. A meta-analysis of the eligible datasets was conducted using Bazett's formula, with subgroup analysis to explore the heterogeneity. Additionally, thirty-eight patients with AF who underwent radiofrequency catheter ablation were enrolled and followed-up for 3-36 months. Univariate and multivariate Cox models were used to calculate the hazard ratios (HRs) and determine the relationship between clinical factors and AF recurrence. Kaplan-Meier survival analysis and ROC curve were conducted to assess the impact and predictive efficacy of individual factors.
Eleven datasets from nine eligible studies were enrolled and meta-analysed. We found that patients with prolonged QTc interval was associated with a significantly higher AF incidence risk, and the risk increased with every 10-ms prolongation. However, this association was not significant in the AF recurrence subgroup. In our prospective cohort, the preoperative body mass index, QTc, left atrial diameter (LAD), and uric acid levels influenced AF recurrence. Multivariate Cox regression analysis identified LAD as an independent factor affecting AF recurrence in patients with a high predictive efficiency. Kaplan-Meier survival analysis showed that increased LAD (>4.5 cm) was associated with postoperative AF recurrence.
Therefore, LAD has better predictive power and can be an indicator for predicting postoperative AF recurrence.
校正QT间期（QTc）是心电图上的心室复极标志物。既往研究评估了其在预测心房颤动（AF）发生方面的价值。然而，其对AF复发的预测效能仍存在争议。
我们在PubMed和谷歌数据库中检索了2024年1月之前评估QTc间期与AF发生率之间关联的研究。使用巴泽特公式对符合条件的数据集进行荟萃分析，并进行亚组分析以探讨异质性。此外，纳入38例接受射频导管消融的AF患者，并随访3至36个月。使用单因素和多因素Cox模型计算风险比（HRs），并确定临床因素与AF复发之间的关系。进行Kaplan-Meier生存分析和ROC曲线分析以评估个体因素的影响和预测效能。
纳入并荟萃分析了来自9项符合条件研究的11个数据集。我们发现QTc间期延长的患者发生AF的风险显著更高，且每延长10毫秒风险增加。然而，这种关联在AF复发亚组中并不显著。在我们的前瞻性队列中，术前体重指数、QTc、左心房直径（LAD）和尿酸水平影响AF复发。多因素Cox回归分析确定LAD是影响AF复发的独立因素，预测效率高。Kaplan-Meier生存分析表明，LAD增加（>4.5 cm）与术后AF复发相关。
因此，LAD具有更好的预测能力，可作为预测术后AF复发的指标。
