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目的观察经三维电解剖标测系统指导下成功的环肺静脉隔离导管射频消融术本身对阵发性房颤患者P波离散度(Pd)的影响。方法选取在三维电解剖标测系统(Ensite或Carto)指导下行环肺静脉隔离经导管射频消融治疗阵发性房颤患者38例。分别记录研究对象术前及术后第3天窦性心律时体表心电图(ECG)及心脏彩超(同一操作者),其中ECG各导联P波间期最大值(Pmax)与最小值(Pmin)之间的差值即Pd。结果经导管环肺静脉隔离阵发性房颤射频消融术前Pmin和Pmax分别为(57.8±15.8)、(128.9±25.8)ms,术后分别为(60.1±14.3)、(115±20.6)ms,其中Pmax手术前后比较P<0.01。Pd手术前后分别为(71.1±17.5)、(54.7±15.6)ms,P<0.01。进一步分析Pd和左房大小的关系表明,不仅术前Pd和术前左心房大小未见明显相关(P=0.437),同时手术前后Pd变化亦与术前左心房大小无显著相关(P=0.208)。结论尽管阵发性房颤Pd与左心房大小无关,但成功的环肺静脉隔离导管射频消融手术本身即能显著减少Pmax和Pd,提示其对阵发性房颤患者心房内非均质性电活动具有改善作用。
Objective To observe the effect of radiofrequency ablation of circumferential pulmonary vein isolation catheter guided by three-dimensional electroanatomic mapping system on P wave dispersion (Pd) in patients with paroxysmal atrial fibrillation. Methods Thirty - eight patients with paroxysmal atrial fibrillation undergoing circumferential pulmonary vein isolation and guided radiofrequency catheter ablation guided by Ensite or Carto system were selected. The electrocardiogram (ECG) and echocardiography (same operator) were recorded before and 3 days after sinus rhythm respectively. The maximal P wave and the smallest Pmin ) That is the difference between Pd. Results The Pmin and Pmax before radiofrequency catheter ablation of paroxysmal atrial fibrillation were (57.8 ± 15.8) and (128.9 ± 25.8) ms, respectively, and were (60.1 ± 14.3) and (115 ± 20.6) ms respectively Which Pmax before and after surgery compared P <0.01. Pd before and after surgery were (71.1 ± 17.5), (54.7 ± 15.6) ms, P <0.01. Further analysis of the relationship between Pd and left atrium size showed that there was no significant correlation between preoperative Pd and preoperative left atrial size (P = 0.437), and there was no significant correlation between preoperative and postoperative Pd changes and preoperative left atrial size (P = 0.208 ). Conclusions Despite the fact that Pd of paroxysmal atrial fibrillation has nothing to do with the size of the left atrium, successful radiofrequency catheter ablation of the pulmonary vein isolation catheter itself can significantly reduce Pmax and Pd, suggesting that it has the potential of atrial inhomogeneous electrical activity in patients with paroxysmal atrial fibrillation Improve effect