2026 年第 1 期 第 21 卷

心房颤动患者心电图QRS波时限特点及与导管射频消融术后心律失常的关系

Characteristics of QRS complex duration on electrocardiogram in patients with atrial fibrillation and its relationship with arrhythmia after catheter radiofrequency ablation

作者：王志琴张大勇徐敏殷燕高

英文作者：Wang Zhiqin Zhang Dayong Xu Min Yin Yangao

单位：绵阳四〇四医院心内科，绵阳621000

英文单位：Department of Cardiology Mianyang 404 Hospital Mianyang 621000 China

关键词：心房颤动；QRS波时限；导管射频消融术；心律失常

英文关键词：Atrialfibrillation;QRScomplexduration;Catheterradiofrequencyablation;Arrhythmia

• 摘要：

• 目的 探究心房颤动患者QRS波时限的特点及其与导管射频消融术（RFCA）后复发的关系。方法 回顾性选取2022年5月至2024年10月于绵阳四〇四医院进行RFCA的心房颤动患者188例。根据术后3个月内是否复发，分为复发组（52例）和未复发组（136例）。收集患者的一般资料、QRS波时限、超声指标、入院血常规指标等。采用分层回归模型分析不同临床特征对QRS波时限的影响。采用多因素Logistic回归分析危险因素。采用分层交互分析性别对QRS波时限与RFCA后复发之间关系的影响。采用受试者工作特征（ROC）曲线评估诊断效能。采用限制性立方样条（RCS）分析QRS波时限与RFCA后复发风险的剂量-反应关系。结果 分层回归分析显示，心电图f波类型、B型脑钠肽（BNP）、同型半胱氨酸（Hcy）、左心房内径（LAD）、左心室射血分数（LVEF）均会对QRS波时限产生显著影响（均P<0.05）。多因素分析显示，心电图f波类型、BNP、Hcy、QRS波时限、LAD、LVEF均为心房颤动患者RFCA后复发的独立影响因素（均P<0.05）。交互检验分析显示，性别不能影响QRS波时限与RFCA后复发之间的关系（P交互>0.05）。QRS波时限高危组（＞150 ms）发生术后复发风险为68.8%（22/32），区间似然比＝4.400。ROC曲线分析结果表明，QRS波时限对RFCA后复发风险诊断效能的曲线下面积为0.753。RCS分析显示，QRS波时限与心房颤动患者RFCA后复发风险呈非线性剂量-反应关系（P<0.05）。结论 QRS波时限延长是心房颤动患者RFCA后复发的独立危险因素，术前测量QRS波时限可有效识别高风险患者，为个体化术后管理提供参考。

• Objective To explore the characteristics of QRS complex duration in patients with atrial fibrillation and its relationship with recurrence after radiofrequency catheter ablation (RFCA). Methods A total of 188 patients with atrial fibrillation who underwent RFCA at Mianyang 404 Hospital from May 2022 to October 2024 were selected retrospectively. According to whether recurrence occurred within 3 months after surgery, the patients were divided into the recurrence group (n=52) and non-recurrence group (n=136). General data, QRS complex duration, ultrasonic parameters, and admission routine blood test indicators of the patients were collected. A hierarchical regression model was used to analyze the effects of different clinical characteristics on QRS complex duration. Multivariate Logistic regression was applied to analyze risk factors. Stratified interaction analysis was conducted to explore the effect of gender on the relationship between QRS complex duration and recurrence after RFCA. Receiver operating characteristic (ROC) curve was used to evaluate diagnostic efficacy. Restricted cubic spline (RCS) was employed to analyze the dose-response relationship between QRS complex duration and the risk of recurrence after RFCA. Results Hierarchical regression analysis showed that electrocardiographic f-wave pattern, brain natriuretic peptide (BNP), homocysteine (Hcy), left atrial diameter (LAD), and left ventricular ejection fraction (LVEF) all had significant effects on QRS complex duration (all P<0.05). Multivariate analysis revealed that electrocardiographic f-wave pattern, BNP, Hcy, QRS complex duration, LAD, and LVEF were independent influencing factors for recurrence in atrial fibrillation patients after RFCA (all P<0.05). Interaction test analysis indicated that gender had no impact on the relationship between QRS complex duration and recurrence after RFCA (Pinteraction>0.05). The risk of postoperative recurrence in the high-risk group of QRS complex duration (>150 ms) was 68.8%(22/32), with an interval likelihood ratio of 4.400. ROC curve analysis results showed that the area under the curve of QRS complex duration for diagnosing the risk of recurrence after RFCA was 0.753. RCS analysis demonstrated that there was a non-linear dose-response relationship between QRS complex duration and the risk of recurrence in atrial fibrillation patients after RFCA (P<0.05). Conclusion  sProlonged QRS complex duration is an independent risk factor for recurrence in patients with atrial fibrillation after RFCA. Preoperative measurement of QRS complex duration can effectively identify high-risk patients and provide a reference for individualized postoperative management.