Noninvasive Time and Frequency Predictors of Long-Standing Atrial Fibrillation Early Recurrence after Electrical Cardioversion
Noninvasive Time and Frequency Predictors of Long-Standing Atrial Fibrillation Early Recurrence after Electrical Cardioversion
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DOI：
10.1111/j.1540-8159.2011.03125.x
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发表时间：
2011-10-01
影响因子：
1.8
通讯作者：
Rieta, Jose J.
中科院分区：
文献类型：
--
作者：
Alcaraz, Raul;Hornero, Fernando;Rieta, Jose J.
背景资料：几个临床因素已被研究，以预测房颤（AF）复发后，电复律（ECV）有限的predictive value.Methods：一种方法能够预测强大的长期AF早期复发的特征非侵入性的电心房活动（AA）与参数相关的时间过程和频谱特征。在这方面，研究了63例因持续性AF转诊进行ECV的患者（20例男性和43例女性;平均年龄73.4 ± 9.0岁;接受胺碘酮抗心律失常药物治疗）。在4周的随访中，41例患者（65.1%）观察到AF复发。结果：RR变异性和研究的AA频谱特征，包括主心房频率（ARF），其第一谐波和振幅，组间的统计学差异较差。相反，f波功率（fWP）和样本熵（SampEn）的AA表现为非常好的预测。AF复发患者的fWP较低（0.036 +/- 0.019 vs 0.081 +/- 0.029 n.u. (2)，P < 0.001）和较高的SampEn（0.107 +/- 0.022对0.086 +/- 0.033，P < 0.01）。此外，fWP的预测准确率最高，为82.5%，而SampEn的预测准确率为79.4%。其余的特征显示准确率低于70%。逐步判别分析（SDA）提供了一个模型的基础上，fWP和SampEn与90.5%的accuracy.Conclusions：fWP已被证明可以预测长期AF早期复发后ECV，并可以结合SampEn，以提高其诊断能力。此外，对结果的全面分析允许概述这两个特征与心房重构的伴随状态之间的可能关联。(PACE 2011; 34：1241-1250）
Background: Several clinical factors have been studied to predict atrial fibrillation (AF) recurrence after electrical cardioversion (ECV) with limited predictive value.Methods: A method able to predict robustly long-standing AF early recurrence by characterizing noninvasively the electrical atrial activity (AA) with parameters related to its time course and spectral features is presented. To this respect, 63 patients (20 men and 43 women; mean age 73.4 +/- 9.0 years; under antiarrhythmic drug treatment with amiodarone) who were referred for ECV of persistent AF were studied. During a 4-week follow-up, AF recurrence was observed in 41 patients (65.1%).Results: RR variability and the studied AA spectral features, including dominant atrial frequency (DAF), its first harmonic and their amplitude, provided poor statistical differences between groups. On the contrary, f waves power (fWP) and Sample Entropy (SampEn) of the AA behaved as very good predictors. Patients who relapsed to AF presented lower fWP (0.036 +/- 0.019 vs 0.081 +/- 0.029 n.u.(2), P < 0.001) and higher SampEn (0.107 +/- 0.022 vs 0.086 +/- 0.033, P < 0.01). Furthermore, fWP presented the highest predictive accuracy of 82.5%, whereas SampEn provided a 79.4%. The remaining features revealed accuracies lower than 70%. A stepwise discriminant analysis (SDA) provided a model based on fWP and SampEn with 90.5% of accuracy.Conclusions: The fWP has proved to predict long-standing AF early recurrence after ECV and can be combined with SampEn to improve its diagnostic ability. Furthermore, a thorough analysis of the results allowed outlining possible associations between these two features and the concomitant status of atrial remodeling. (PACE 2011; 34:1241-1250)