The Predictive Value Of P-wave Morphology Of Surface Electrocardiogram In Patients Under Different Left Atrial Diameter With Paroxysmal Atrial Fibrillation

Background and aim:Atrial fibrillation(AF)is one of the most common arrhythmia in clinical,and atrial mechanical function is lost when it occurs,which leading to serious complications,such as heart failure,stroke,etc.Therefore,early detection and treatment of atrial fibrillation is crucial,which can significantly reduce the occurrence rate of complications caused by atrial fibrillation and the mortality rate caused by atrial fibrillation and its complications.The diagnosis of paroxysmal atrial fibrillation is very easy to be missed in clinical work.This study aimed to investigate the predictive value of P-wave morphology of surface electrocardiogram in all patients of this study and P-wave morphology of surface electrocardiogram in patients under different left atrial diameter for paroxysmal atrial fibrillation and to study the sensitivity,specificity,positive predictive value and negative predictive value of important predictive indexs to predict the occurrence of paroxysmal atrial fibrillation.And then the optimal indexs of P-wave shape is obtained to predict the occurrence of paroxysmal atrial fibrillation in different segments of left atrial diameter,which could provide early warning for the diagnosis of paroxysmal atrial fibrillation and reduce the patients' life safety threat finally.Method:A total of 219 patients with paroxysmal atrial fibrillation who were performed by surgical treatment(Radiofrequency ablation or cryoballoon ablation)and were treated in the department of cardiovascular internal medicine,the First Hospital ofJilin University from January 2018 to November 2019 were enrolled in the experimental group.According to the principle of simultaneous admission,219 cases of patients who were identified without paroxysmal atrial fibrillation were enrolled in the control group.Clinical data of the above patients(age,gender,whether combined with hypertension,P-wave terminal potential of lead V1,maximum P-wave duration,minimum P-wave duration,left anterior and posterior atrial diameter,left ventricular ejection fraction)were collected and collated for retrospective analysis.Univariate analysis and multivariate Logistic regression model analysis were conducted on the indexs that might affect the occurrence of paroxysmal atrial fibrillation,and the relevant factors which could predict the occurrence of paroxysmal atrial fibrillation effectively were acquired.The receiver operating characteristic curve(ROC curve)was applied to evaluate the predictive value of relevant indexs for the occurrence of paroxysmal atrial fibrillation,and the cutoff value for the prediction of paroxysmal atrial fibrillation was determined according to the Youden index.According to the size(LAD?40mm,35mm?LAD < 40 mmand LAD < 35mm)of left atrial diameter(anteroposterior diameter),both patients of the experimental group and control group was divided into there groups,and each group was analyzed respectively to acquire the predictive value(specific degree,positive predictive value and negative predictive value)of paroxysmal atrial fibrillation.The best prediction index in a certain interval of left atrial diameter and the prediction value rule of each prediction index in different intervals of left atrial diameter were obtained by analyzing the total samples and the specific prediction results of each prediction index in each group of left atrial diameter.Results:Results of univariate analysis between the atrial fibrillation and non-atrial fibrillation group: single factor analysis showed that some parameters(sex,Pmax,Pmin,PTFV1,LAD)were statistically significant differences between the experimental group and control group(P < 0.05).Multivariate Logistic regression analysis indicated that Pmax(95%CI: 1.031-1.077 P < 0.001),Pmin(95%CI:1.046-1.101 P<0.001),and PTFV1(95%CI: 0.000-0.309 P=0.034)were important indexes to predict the occurrence of paroxysmal atrial fibrillation.The ROC curve was used to evaluate the predictive value of Pmax,Pmin and PTFV1 for the occurrence of paroxysmal atrial fibrillation.The results showed that the area under the ROC curve of Pmaxfor predicting the occurrence of paroxysmal atrial fibrillation was 0.875,and the optimal critical value determined by the Youden index was 132.5ms.The area under the ROC curve of Pmin for predicting the occurrence of paroxysmal atrial fibrillation was 0.831,and the optimal critical value determined by the Youden index was 102.6ms.The area under ROC curve of PTFV1 for predicting the occurrence of paroxysmal atrial fibrillation was 0.692,and the optimal critical valuedetermined by the Youden indexwas-0.018mm·s.Secondly,the aboveindicators were combined in pairs and in whole to evaluate their predictive value for predicting the occurrence of paroxysmal atrial fibrillation.The results suggested that the area under ROC curve of Pmax combined with Pmin for predicting the occurrence ofparoxysmal atrial fibrillation was 0.877.The area under ROC curve of Pmax combined with PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was 0.882.The area under ROC curve of Pmin combined with PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was 0.845.The area under ROC curve of Pmax combined with Pmin and PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was 0.881.Finally,the comprehensive predictive value of the above indicators was compared and analyzed.The results showed that Pmax,Pmax combined with Pmin,Pmax combined with PTFV1,Pmax combined with Pmin and PTFV1 had the highest predictive value,and there was no statistical differencebetween the four groups(P > 0.05).The predictive value of Pmin combined with PTFV1 was next.Pmin and PTFV1 had the lowest predictive value.Patients in the AF group and non-AF group were divided into three groups according to the size of left atrial diameter(LAD?40mm,35mm?LAD< 40 mm,and LAD<35mm).In the group of LAD?40mm,ROC curve was used to evaluate the predictive value of Pmax,Pmin and PTFV1 for predicting the occurrence of parvoatrial fibrillation.The results showed thatthe area under the ROC curve of Pmaxfor predicting the occurrence of paroxysmal atrial fibrillation was 0.873,and the optimal critical value determined by the Youden index was 140.4ms.The area under the ROC curve of Pmin for predicting the occurrence of paroxysmal atrial fibrillation was 0.870,and the optimal critical value determined by the Youden index was102.4ms.The area under ROC curve of PTFV1 for predicting the occurrence of paroxysmal atrial fibrillation was 0.681,and the optimal critical valuedetermined by the Youden indexwas-0.032mm·s.Secondly,the aboveindicators were combined in pairs and in whole to evaluate their predictive value for predicting the occurrence of paroxysmal atrial fibrillation.The results suggested that the area under ROC curve of Pmax combined with Pmin for predicting the occurrence ofparoxysmal atrial fibrillation was 0.896.The area under ROC curve of Pmax combined with PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was 0.873.The area under ROC curve of Pmin combined with PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was 0.870.The area under ROC curve of Pmax combined with Pmin and PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was 0.896.Finally,the comprehensive predictive value of the above indicators was compared and analyzed.The results showed that Pmax,Pmin,Pmax combined with Pmin,Pmax combined with PTFV1,Pmin combined with PTFV1,Pmax combined with Pmin and PTFV1 had the highest predictive value,andthere was no statistical difference between the six groups(P > 0.05).PTFV1 had the lowest predictive value.In the group of 35mm?LAD<40mm,ROC curve was used to evaluate the predictive value of Pmax,Pmin and PTFV1 for predicting the occurrence of parvoatrial fibrillation.The results showed thatthe area under the ROC curve of Pmaxfor predicting the occurrence of paroxysmal atrial fibrillation was 0.882,and the optimal critical value determined by the Youden index was 132.5ms.The area under the ROC curve of Pmin for predicting the occurrence of paroxysmal atrial fibrillation was 0.811,and the optimal critical value determined by the Youden index was105.0ms.The area under ROC curve of PTFV1 for predicting the occurrence of paroxysmal atrial fibrillation was 0.702,and the optimal critical valuedetermined by the Youden indexwas-0.018mm·s.Secondly,the aboveindicators were combined in pairs and in whole to evaluate their predictive value for predicting the occurrence of paroxysmal atrial fibrillation.The results suggested that the area under ROC curve of Pmax combined with Pmin,Pmin combined with PTFV1 and Pmax combined with Pmin and PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was0.811.The area under ROC curve of Pmax combined with PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was 0.851.Finally,the comprehensive predictive value of the above indicators was compared and analyzed.The results showed that Pmax and Pmax combined with PTFV1 had the highest predictive value,and there was no statistical difference between the two groups(P > 0.05).The predictive value of Pmin,Pmax combined with Pmin,Pmin combined with PTFV1,Pmax combined with Pmin and PTFV1 was next,and there was no statistical difference between the four groups(P > 0.05).PTFV1 had the lowest predictive value.In the group of LAD<35mm,ROC curve was used to evaluate the predictivevalue of Pmax,Pmin and PTFV1 for predicting the occurrence of parvoatrial fibrillation.The results showed thatthe area under the ROC curve of Pmaxfor predicting the occurrence of paroxysmal atrial fibrillation was 0.866,and the optimal critical value determined by the Youden index was 136.4ms.The area under the ROC curve of Pmin for predicting the occurrence of paroxysmal atrial fibrillation was0.812,and the optimal critical value determined by the Youden index was 102.5ms.The area under ROC curve of PTFV1 for predicting the occurrence of paroxysmal atrial fibrillation was 0.653,and the optimal critical valuedetermined by the Youden indexwas-0.012mm·s.Secondly,the aboveindicators were combined in pairs and in whole to evaluate their predictive value for predicting the occurrence of paroxysmal atrial fibrillation.The results suggested that the area under ROC curve of Pmax combined with Pmin was 0.885.The area under ROC curve of Pmax combined with PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was 0.870.The area under ROC curve of Pmin combined with PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was 0.883.The area under ROC curve of Pmax combined with Pmin and PTFV1 for predicting the occurrence ofparoxysmal atrial fibrillation was 0.827.Finally,the comprehensive predictive value of the above indicators was compared and analyzed.The results showed that Pmax combined with Pmin,Pmax combined with PTFV1 and Pmax combined with Pmin and PTFV1 had the highest predictive value,and there was no statistical difference between the three groups(P > 0.05).The predictive value of Pmax,Pmin and Pmin combined with PTFV1 was next,and there was no statistical difference between the three groups(P >0.05).PTFV1 had the lowest predictive value.Conclusion:1.Pmax,Pmin and PTFV1 are important indicators for the prediction of the occurrence of paroxysmal atrial fibrillation.2.Pmax is the best predictor in total samples,the group of LAD?40mmand the group of LAD ? 35 mm group < 40 mm.In the the group of LAD < 35 mm,the best predictors are Pmax combined with PTFV1 or(and)Pmin.3.PTFV1 has the lowest predictive value for the occurrence of paroxysmal atrial fibrillation in the total sample andthe groups with different left atrial diameter segments.