Clinical Study On Paroxysmal Atrial Fibrillation And P Wave Peak Time

Objective This study collected the clinical data of patients with paroxysmal atrial fibrillation and matched healthy people for case-control study,in order to explore the relationship between new ECG parameters P-wave peak time and classical P-wave ECG parameters and atrial fibrillation,and whether P-wave peak time can be used as a predictor of atrial fibrillation.Methods:70 patients with paroxysmal atrial fibrillation in the First Affiliated Hospital of Inner Mongolia Medical University from January 2020 to the end of October 2021 were selected as the atrial fibrillation group,and 70 patients with non atrial fibrillation in our hospital during the same period were selected as the control group.Sort out the clinical case data of all subjects and collect the required data,including general baseline data,laboratory results,echocardiography and ECG data.P-wave ECG parameters in ECG data include PR interval（PR）,P-wave maximum duration（Pmax）,P-wave minimum duration（Pmin）,P-wave dispersion（PD）,P-wave terminal force in lead V₁（PTFV₁）,V₁lead negative P-wave amplitude（PPAV₁）and new ECG parameter P-wave peak time（PWPT）,Statistical software was used to analyze and compare whether there were significant differences in P-wave ECG parameters and various indexes between atrial fibrillation group and control group,and to analyze the relationship between the new ECG parameter P-wave peak time and atrial fibrillation.Results:（1）There was no significant difference in age,sex,alcohol consumption,smoking and associated diseases between atrial fibrillation group and control group（P>0.05）;There were significant differences in red blood cell distribution width（RDW）（13.25±0.84 VS12.92±0.67;P=0.012）and serum cystatin C（Cysc）（1.01±0.31 VS 0.91±0.22;P=0.031）between atrial fibrillation group and control group（P<0.05）,but there was no significant difference in other laboratory results between the two groups（P>0.05）.（2）Among the echocardiographic indexes of AF group and control group,the left atrial anterior posterior diameter（LAD）（39.04±4.83 vs 33.57±4.54mm;P<0.001）and right atrial transverse diameter（RAD）（37.10±4.27 vs 32.34±4.72mm;P<0.001）in AF group were significantly higher than those in control group,and the left ventricular ejection fraction（LVEF）in control group was higher than that in AF group（65.19±4.01 vs 62.87±6.06%;P=0.009）,There were significant differences between the two groups in the above echocardiographic characteristics（P<0.05）,and there was no significant difference in other echocardiographic characteristics between the two groups（P>0.05）.（4）Among the main ECG parameters of P wave in AF group,PR（165.83±20.19 vs 149.00±15.61ms;P<0.001）,PD（53.73±7.16 vs 47.54±6.77 ms;P<0.001）,Pmax（121.91±9.04 vs 113.96±10.36ms;P<0.001）,PWPTDII（65.00±8.10 vs 56.74±7.84ms;P<0.001）and PWPTDV₁（59.26±9.04 vs 46.59±10.72ms;P<0.001）were significantly longer than those in the control group,There was significant difference between the two groups（P<0.05）,but there was no significant difference in other P wave main ECG parameters and other ECG parameters between the two groups（P>0.05）.Univariate and multivariate regression analysis showed that there was a significant independent relationship between PWPTDII and PWPTDV₁and atrial fibrillation（PWPTDII,OR:0.903;95%CI:0.842～0.970,P=0.005;PWPTDV₁,OR:0.900;95%CI:0.853～0.949,P<0.001）.The analysis of test working curve（ROC curve）showed that the area under PWPTDII curve was 0.758,and the optimal cut-off point value of PWPTDII was 57.5ms,The sensitivity and specificity of predicting the occurrence of atrial fibrillation were 82.9%and 60%;The area under PWPTDV₁curve was0.816,and the optimal cut-off point of PWPTDV₁was 48.5ms.The sensitivity and specificity of predicting atrial fibrillation were 85.7%and 64.5%.Conclusion:（1）The P-wave peak time is closely related to the occurrence of atrial fibrillation.It is an independent risk factor of atrial fibrillation and can be used as a predictor of atrial fibrillation.（2）The prediction effect of P-wave peak time on the occurrence of atrial fibrillation is better than ECG parameters such as PR interval,P-wave dispersion and P-wave duration.