P波峰值时间、R波峰值时间联合V1-V3转移指数对心房颤动患者射频消融术后复发的预测价值OA

Objective To explore the predictive value of P-wave peak time(PWPT),R-wave peak time(RWPT)combined with the V1-V3 transition index(V1-V3 TI)for recurrence in patients with atrial fibrillation(AF)after radiofrequen-cy ablation,providing a reference for early clinical identification of patients at high risk of recurrence.Methods A total of 130 AF patients who underwent radiofrequency ablation in the Department of Cardiovascular Medicine,Nanchong Hospital of Beijing Anzhen Hospital,Capital Medical University,from February 2022 to January 2025 were enrolled and followed up for 12 months.According to the recurrence outcome,patients were divided into a recurrence group(42 cases)and a non-recur-rence group(88 cases).Preoperative PWPT,RWPT,and V1-V3 TI were measured using an electrocardiograph.Clinical data and serum biomarker levels were compared between the two groups.Multivariate logistic regression was used to identify inde-pendent risk factors for postoperative recurrence;relative risks were calculated to analyze the association between different in-dicator levels and recurrence;and receiver operating characteristic(ROC)curves were constructed to evaluate the predictive value of each indicator alone and in combination.Results The levels of PWPT,RWPT,and V1-V3 TI in the recurrence group were significantly higher than those in the non-recurrence group(t=11.811,9.868,8.945,respectively;all P<0.001).The levels of PWPT,RWPT,and V1-V3 TI in the early-recurrence subgroup were significantly higher than those in the late-recur-rence subgroup(t=12.345,11.876,13.567,respectively;all P<0.001).Age,history of hypertension,type of AF,duration of AF,and hs-CRP showed no statistically significant differences in multivariate analysis(all P>0.05).Enlarged left atrial diame-ter(LAD),elevated BNP,prolonged PWPT,prolonged RWPT,and elevated V1-V3 TI were independent risk factors for recur-rence after radiofrequency ablation in AF patients[OR(95%CI)=2.678(1.432-4.998),2.345(1.213-4.532),3.125(1.789-5.482),2.896(1.567-5.354),3.452(1.987-6.013)],whereas higher left ventricular ejection fraction(LVEF)was a protective factor[OR(95%CI)=0.949(0.925-0.974)].Relative risk analysis showed that the postoperative recurrence risks for patients with high levels of PWPT,RWPT,and V1-V3 TI were 1.796,1.841,and 1.910 times higher,respectively,compared to those with low levels(χ2/P=7.654/0.006,6.892/0.009,8.321/0.004).ROC curve analysis revealed that the area under the curve(AUC)for PWPT,RWPT,V1-V3 TI alone,and their combination for predicting recurrence after radiofrequency ablation in AF patients were 0.826,0.798,0.835,and 0.942,respectively.The combined model demonstrated significantly better predictive performance than any single indicator(Z/P=3.567/0.001,3.892/0.001,3.415/0.001).Conclusion Prolonged PWPT,prolonged RWPT,and elevated V1-V3 TI are independent risk factors for recurrence after radiofrequency ablation in patients with atrial fibrillation.The combined detection of these three parameters has higher predictive value for postoperative recur-rence,providing a basis for clinical risk stratification and individualized intervention.