Value and Clinical Significance of Body Surface Electrocardiogram-Related Parameters in Predicting the Recurrence of Atrial Fibrillation after Radio-frequency Ablation

LIU Xinyu; SUN Yali; ZHANG Xuelian; LIU Shengnan; FEI Pingyan; ZHANG Yujing; SUN Tao

doi:10.3969/j.issn.1002-3429.2023.07.020

Abstract：Objective To investigate the value of body surface electrocardiogram(ECG)-related parameters in pre-dicting the recurrence of atrial fibrillation(AF)after radiofrequency ablation(RFCA),and to analyze its clinical signifi-cance.Methods All 542 AF cases admitted from January 2019 to August 2021 were treated with RFCA,and divided into re-currence group(n =72)and non-recurrence group(n =470)according to presence of recurrence at 6 months after surgery.The clinical data,body surface ECG-related parameters[mean amplitude of f-wave in V1 lead,P-wave time duration(PWD),maximum P-wave duration(Pmax),P-wave dispersion(Pd)]and the difference in the change of each parameter were com-pared between the two groups,and the relationship between the difference in the change of each parameter and the risk of re-currence after surgery and its predictive value were analyzed.Results In the recurrence group,the age and right atrial inter-nal diameter were greater than those in the non-recurrence group,the duration of the disease was longer than that in the non-recurrence group,and the proportion of combined hypertension was higher than that in the non-recurrence group(P＜0.01).The mean amplitude of f-wave at 1 day after surgery in two groups was longer than that before surgery,while PWD,Pmax,and Pd were lower than those before surgery(P＜0.05).The mean amplitude of f-wave before and at 1 day after surgery in the re-currence group was shorter than that in the non-recurrence group,while PWD,Pmax,and Pd were higher than those in the non-recurrence group(P＜0.01).The difference in the mean amplitude of f-wave,PWD,Pmax and Pd in the recurrence group was less than that in the non-recurrence group(P＜0.01).Hazard analysis showed that the risk of postoperative AF re-currence was significantly increased when the difference in changes in mean amplitude of f-wave, PWD, Pmax, and Pd was low, with OR of 2.394, 2.578, 2.103, and 1. 913, respectively, and 95％ CI of 1. 991, 2. 878, 2. 202, 3. 019, 1. 790, 2. 472, 1.583 and 2.312, respectively. Analysis of the receiver operating characteristic (ROC) curves showed that the area under the ROC curve (AUC) and95％ CI were0.931 and0.907,0.951 respectively for the combined prediction of postop-erative recurrence by the difference in change in mean amplitude of f-wave, PWD, Pmax, and Pd, which were greater than that predicted by the difference in change in each parameter alone. Conclusion The difference in mean amplitude of f-wave, PWD, Pmax and Pd has a strong predictive value for postoperative recurrence in AF patients with RFCA. Combined detection is beneficial to prevent postoperative recurrence and improve postoperative life quality of patients.