Correlation Between The Characteristics Of F Wave In Lead V1 And The Occurrence Of Ischemic Stroke In Patients With Persistent Atrial Fibrillation

ObjectiveAtrial fibrillation(AF)is a common arrhythmia,and its ischemic stroke(IS)risk is6-8 times that of non-AF patients.Compared with those without AF,the fatality and disability rate of AF-related strokes and the number of hospitalization days increased significantly.During the persistence of AF,the electrocardiogram showed f waves with different size,amplitude and frequency.This study aims to explore the relationship between the characteristics of the f waves on the body surface electrocardiogram(lead V1)and persistent AF without valvular lesion complicated with IS,and try to find a probable method to predict the occurrence of IS in patient with persistent AF.MethodThe study is a retrospective analysis.A total of 228 patients who met the criteria were included in the Second Affiliated Hospital of Dalian Medical University from January 2018 to July 2020.Based on the presence or absence of IS,the patients were divided into two groups,AF with IS group(n=121 cases)and AF without IS group(n=107 cases).According to whether the patients had IS for the first time,they were divided into initial IS group(n=70 cases)and of recurrent IS group(n=51 cases).The general information,past history,cormorbidity,serology,cardiac ultrasound and body surface electrocardiogram lead V1(frequency and amplitude of f-wave),etc,were collected and analyzed.Statistical method: SPSS 23.0 software was used for data analysis.The measurement data that obeys the normal distribution are expressed as mean ± standard deviation(?x±s),and the comparison between groups is by t test;the measurement data of skewed distribution is expressed as the median M(P25,P75),using Mann-Whitney U test compares the differences between the two groups.The enumeration data is expressed as a percentage(%),and the chi-square test is used for comparison between groups.Multivariate analysis uses multiple Logistic regression model analysis.The risk estimate is expressed by OR and 95% confidence interval.P<0.05 is a statistically significant difference.ResultThe duration of atrial fibrillation in the AF with IS group was significant longer than AF without IS group [99(56-177)months vs 57(21-111)months,P=0.000].CHA2DS2-VASc score(4.08±1.76 vs 2.9±1.66,P=0.000),D-2-mer [0.58(0.45-0.85)μg/ml vs 0.53(0.35-0.83)μg/ml,P=0.021],BNP [229.4(142.9-351.1)pg/ml vs 147.8(109.0-239.8),P=0.001],left atrium diameter(45.53 ± 6.11 mm vs 43.15 ± 8.77 mm,P=0.003)were significant higher in AF with IS group than AF without IS group.The percentage combined with hypertension(82.6% vs 67.2%,P=0.009),diabetes(52.3% vs33.6%,P=0.005),and the history of thromboembolism(42.1% vs 9.3%,P=0.000)were significant higher in AF with IS group than AF without IS group.APTT [35.6(32.7-40.0)s vs 36.6(34.3-40.3)s,P=0.014],f wave amplitude(0.0524±0.0177 m V vs 0.0773± 0.0293 m V,P=0.000)were significant lower in AF with IS group compared with AF without IS group.Multivariate logistic regression analysis found that the history of thromboembolism(OR=10.257,95%CI 3.746-28.085,P=0.000),BNP(OR=1.006,95%CI 1.002-1.009,P=0.001),left atrial diameter(OR=1.078,95%CI 1.018-1.143,P=0.011),f wave amplitude(OR=7.067,95%CI 2.852-17.511,P=0.000)are independent risk factors for AF with IS group.The ROC curve was drawn and it was found that the area under the ROC curve,the best cut-off value,sensitivity,and specificity of the left atrial diameter in the diagnosis of AF with IS were 0.609,39.95 mm,86%,and 37%,respectively,P=0.01.The area under the ROC curve,the best cut-off value,sensitivity and specificity of BNP in the diagnosis of AF with IS were0.645,257.15 pg/m L,43%,and 79%(P=0.001).The area under the curve,the best cut-off value,sensitivity and specificity for the diagnosis of f wave amplitude for AF without IS were 0.767,0.06 m V,65%,82%(P=0.000).AF duration in the recurrent IS group was significantly longer than that in the initial IS group [104.00(56.00-177.00)months vs 58(24.00-104.25)months,P=0.001].CHA2DS2-VASc score(5.31±1.36 vs 3.19±1.46,P=0.000)and left atrial diameter[43.80(40.30-48.98)mm vs 43.20(38.48-47.00)mm,P=0.034] were significantly higher in the recurrent IS group than the initial IS group.The percentage combined with hypertension(94.1% vs 74.3%,P=0.006)and f-wave frequency(439.29 ± 49.76 fpm vs408.21 ± 43.75 fpm,P =0.000)were significantly higher in recurrent IS group than the initial IS group.Multivariate logistic regression analysis found that f-wave frequency(OR=1.028,95%CI 1.008-1.048,P=0.007)and CHA2DS2-VASc score(OR=4.264,95%CI 2.331-7.801,P=0.000)were independent predictors of IS recurrence.The area under the ROC curve of f-wave frequency for diagnosis of IS recurrence,the best cutoff value,sensitivity,and specificity were 0.689,405 fpm,78%,and 61%(P=0.000).The area under the ROC curve for the CHA2DS2-VASc score to diagnose IS recurrence,the best cut-off value,sensitivity and specificity are 0.847,4.5 points,71%,79%.AFR was positively correlated with AF duration(R=0.253,P=0.000),left atrial diameter(R=0.502,P=0.000).AFR was negatively correlated with age(R=-0.248,P=0.000)and ventricular rate(R=-0.206,P=0.002).The f wave amplitude was negatively correlated with age(R=-0.139,P=0.035),AF duration(R=-0.354,P=0.000),and positively correlated with ventricular rate(R=0.176,P=0.008).Conclusion1.In patients with persistent non-valvular atrial fibrillation,the reduction of the fwave amplitude in lead V1 of the surface electrocardiogram is associated with the occurrence of stroke;2.Increased atrial frequency in lead V1 of the surface electrocardiogram in patients with persistent non-valvular atrial fibrillation is associated with stroke recurrence.