Abe Y, Fukunami M, Yamada T, Ohmori M, Shimonagata T, Kumagai K, Kim J, Sanada S, Hori M, Hoki N
Division of Cardiology, Osaka Prefectural Hospital, Japan.
Circulation. 1997 Oct 21;96(8):2612-6. doi: 10.1161/01.cir.96.8.2612.
It is well known that paroxysmal atrial fibrillation (PAF) often precedes the establishment of chronic atrial fibrillation (CAF). However, there have been no definite methods to predict the transition from PAF to CAF. The purpose of this report was to determine prospectively whether P-wave-triggered signal-averaged ECG (P-SAE) is useful for the prediction of the transition to CAF in patients with PAF.
One hundred twenty-two consecutive patients with PAF were prospectively followed after P-SAE, echocardiography, and 24-hour Holter monitoring at study entry. The duration (Ad) and root-mean-square voltage for the last 30 ms (LP30) of the filtered P wave were measured in P-SAE. The abnormality of P-SAE for the prediction of transition to CAF was defined as Ad > or = 145 ms and LP30 < 3.0 microV. Twenty-three (19%; group 1) of the patients had the abnormality of P-SAE, whereas the others (group 2) did not. During the follow-up period (mean, 26+/-12 months), 10 patients (43%) in group 1 acquired CAF, whereas the transition to CAF was observed in only 4 patients (4%) in group 2. Kaplan-Meier analysis revealed that the transition to CAF was significantly observed more often in group 1 than in group 2 (log-rank test, P<.0001). The Cox proportional hazards regression model identified that the variables most significantly associated with the transition to CAF were Ad (chi2=8.6, P=.003) and LP30 (chi2=5.1, P=.02), although significant differences in the left atrial dimension (40.8+/-5.3 versus 37.3+/-5.5 mm, P<.01) and the number of atrial premature contractions (3641+/-4524 versus 1489+/-2895 beats/d, P<.05) were observed between groups 1 and 2.
These results indicate that P-SAE could be useful to identify patients at risk for the transition from PAF to CAF.
众所周知，阵发性心房颤动（PAF）常常先于慢性心房颤动（CAF）的形成。然而，尚无明确方法可预测PAF向CAF的转变。本报告的目的是前瞻性地确定P波触发信号平均心电图（P-SAE）对预测PAF患者向CAF转变是否有用。
对122例连续的PAF患者在研究入组时进行P-SAE、超声心动图和24小时动态心电图监测后进行前瞻性随访。在P-SAE中测量滤波后P波的持续时间（Ad）和最后30毫秒的均方根电压（LP30）。预测向CAF转变的P-SAE异常定义为Ad≥145毫秒且LP30<3.0微伏。23例（19%；第1组）患者存在P-SAE异常，而其他患者（第2组）无异常。在随访期间（平均26±12个月），第1组中有10例患者（43%）发生了CAF，而第2组中仅有4例患者（4%）转变为CAF。Kaplan-Meier分析显示，第1组向CAF的转变明显比第2组更常见（对数秩检验，P<0.0001）。Cox比例风险回归模型确定，与向CAF转变最显著相关的变量是Ad（χ2=8.6，P=0.003）和LP30（χ2=5.1，P=0.02），尽管第1组和第2组之间在左心房内径（40.8±5.3对37.3±5.5毫米，P<0.01）和房性早搏数量（3641±4524对1489±2895次/天，P<0.05）方面存在显著差异。
这些结果表明，P-SAE有助于识别有PAF向CAF转变风险的患者。
