Electrocardiographic predictors of atrial fibrillation
Electrocardiographic predictors of atrial fibrillation
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DOI：
10.1016/j.ahj.2009.08.002
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发表时间：
2009-10-01
影响因子：
4.8
通讯作者：
Froelicher, Victor F.
中科院分区：
文献类型：
--
作者：
Perez, Marco V.;Dewey, Frederick E.;Froelicher, Victor F.
心房颤动（AF）是美国最常见的心律失常，每年有超过750，000例中风。AF的无创预测可能有助于识别患者的风险发展AF。我们的目的是确定与发病AF.Methods心电图的特点，这是一个回顾性队列分析42,751例患者的心电图（ECG）由医生的自由裁量权，并使用计算机系统进行分析。对人群进行随访，以在随后的ECG中检测AF。考克斯比例风险回归分析，以测试这些心电图特征和AF的发展之间的关联。结果平均随访5.3年，1,050（2.4%）例患者被发现有AF在随后的心电图记录。一些ECG特征，如P波离散度（最宽和最窄P波之间的差异）、房性早搏和异常P轴，可预测AF，校正年龄和性别后风险比约为2。P波指数（所有导联P波持续时间的标准差）是房颤最强的预测指标之一，P波指数>35时，一致性指数为0.62，风险比为2.7（95% CI 2.1-3.3）。结论：几种心电图标志物可独立预测房颤的未来发作。P指数是衡量心房去极化紊乱的指标，是房颤最强的预测指标之一。心电图包含有价值的预后信息，可识别房颤风险患者。（Am Heart J 2009;158：622-8）
Background Atrial fibrillation (AF) is the most prevalent arrhythmia in the United States and accounts for more than 750,000 strokes per year. Noninvasive predictors of AF may help identify patients at risk of developing AF. Our objective was to identify the electrocardiographic characteristics associated with onset of AF.Methods This was a retrospective cohort analysis of 42,751 patients with electrocardiograms (ECGs) ordered by physician's discretion and analyzed using a computerized system. The population was followed for detection of AF on subsequent ECGs. Cox proportional hazard regression analysis was performed to test the association between these ECG characteristics and development of AF.Results For a mean follow-up of 5.3 years, 1,050 (2.4%) patients were found to have AF on subsequent ECG recordings. Several ECG characteristics, such as P-wave dispersion (the difference between the widest and narrowest P waves), premature atrial contractions, and an abnormal P axis, were predictive of AF with hazard ratio of approximately 2 after correcting for age and sex. P-wave index, the SD of P-wave duration across all leads, was one of the strongest predictors of AF with a concordance index of 0.62 and a hazard ratio of 2.7 (95% CI 2.1-3.3) for a P-wave index >35. These were among the several independently predictive markers identified on multivariate analysis.Conclusions Several ECG markers are independently predictive of future onset of AF. The P index, a measurement of disorganized atrial depolarization, is one of the strongest predictors of AF. The ECG contains valuable prognostic information that can identify patients at risk of AF. (Am Heart J 2009;158:622-8.)