背景:肺静脉隔离术(PVI)调节固有的心脏自主神经系统并减少房颤(AF)复发。
方法:在本回顾性分析中,我们调查了PVI对心电图导联间P波的影响,R波,和T波异质性(PWH,RWH,TWH)在45例窦性心律患者中接受临床指示的房颤PVI。我们测量了PWH作为心房电离散度和AF敏感性的标志物,RWH和TWH作为室性心律失常风险的标志物以及标准ECG测量。
结果:PVI急性(16±8.9h)将PWH降低了20.7%(从31±1.9降至25±1.6µV,p<0.001)和TWH增加27%(从111±7.8到81±6.5µV,p<0.001)。PVI后RWH无变化(p=0.068)。在20例随访时间较长的患者亚组中(平均=PVI后47±3.7天),PWH保持较低(25±1.7µV,p=0.01),但TWH部分恢复至消融前水平(93±10.2,p=0.16)。3例患者在消融术后前3个月出现房性心律失常早期复发,PWH剧增8.5%,而在没有早期复发的患者中,PWH急剧下降22.3%(p=0.048)。PWH优于其他当代P波指标,包括P波轴,色散,和持续时间预测早期房颤复发。
结论:PVI后PWH和TWH降低的快速时程提示可能通过心脏内在神经系统的消融介导的有益影响。PWH和TWH对PVI的急性反应表明对心房和心室电稳定性具有良好的双重作用,可用于跟踪个体患者的电异质性特征。
BACKGROUND: Pulmonary vein isolation (PVI) modulates the intrinsic cardiac autonomic nervous system and reduces atrial fibrillation (AF) recurrence.
METHODS: In this retrospective analysis, we investigated the impact of PVI on ECG interlead P-wave, R-wave, and T-wave heterogeneity (PWH, RWH, TWH) in 45 patients in sinus rhythm undergoing clinically indicated PVI for AF. We measured PWH as a marker of atrial electrical dispersion and AF susceptibility and RWH and TWH as markers of ventricular arrhythmia risk along with standard ECG measures.
RESULTS: PVI acutely (16 ± 8.9 h) reduced PWH by 20.7% (from 31 ± 1.9 to 25 ± 1.6 µV, p < 0.001) and TWH by 27% (from 111 ± 7.8 to 81 ± 6.5 µV, p < 0.001). RWH was unchanged after PVI (p = 0.068). In a subgroup of 20 patients with longer follow-up (mean = 47 ± 3.7 days after PVI), PWH remained low (25 ± 1.7 µV, p = 0.01), but TWH partially returned to the pre-ablation level (to 93 ± 10.2, p = 0.16). In three individuals with early recurrence of atrial arrhythmia in the first 3 months after ablation, PWH increased acutely by 8.5%, while in patients without early recurrence, PWH decreased acutely by 22.3% (p = 0.048). PWH was superior to other contemporary P-wave metrics including P-wave axis, dispersion, and duration in predicting early AF recurrence.
CONCLUSIONS: The rapid time course of decreased PWH and TWH after PVI suggests a beneficial influence likely mediated via ablation of the intrinsic cardiac nervous system. Acute responses of PWH and TWH to PVI suggest a favorable dual effect on atrial and ventricular electrical stability and could be used to track individual patients\' electrical heterogeneity profile.