Clinical value analysis of quantitative indexes in the differentiation of atrial fibrillation with wide QＲS waves Xu
Jianchang，Lai Xin，Ｒao Panpan，Luo Junmiao，Chen Kui，Wang Xi． Department of Cardiology，Ｒenmin Hospital of Wuhan
University，Hubei Province，Wuhan 430060，China
Corresponding author: Wang Xi，E-mail: xiwangwhu@ 163． com
Funding program: National Natural Science Foundation of China ( 81772044)
【Abstract】 Objective To analyze the clinical value of quantitative indicators related to wide QＲS wave ( pre / syn-rhythmic interval，quasi compensatory interval / pre interval，quasi compensatory interval / synrhythmic interval) in the differen-tiation of atrial fibrillation ( AF) with wide QＲS wave ( AF with ventricular premature beats and ventricular differential trans-
mission) ． Methods From January 2020 to June 2022，113 patients with paroxysmal atrial fibrillation in the Department of Cardiology，People＇s Hospital of Wuhan University were selected for dynamic electrocardiogram，including 80 patients with at-rial fibrillation and ventricular premature beats ( atrial premature group) and 33 patients with atrial fibrillation and ventricular
differential transmission ( atrial differential group ) ． The distribution characteristics and quantitative indicators of the two groups of traditional identification indicators were compared，and the ＲOC curve was drawn to evaluate the clinical value of quantitative indicators in the identification of atrial fibrillation and wide QＲS wave． Ｒesults There was no significant differ-
ence between the two groups in terms of gender，age，smoking history，drinking history，hypertension，coronary heart disease and diabetes ( P ＞ 0． 05) ． The prevalence of heart failure in the atrial premature beats group was higher than that in the atrial arrhythmias group ( χ2 / P = 3． 935 /0． 047) ． In the traditional identification indicators，the association phenomenon of the atrial premature group，the QＲS wave duration ≤ 140 ms，the proportion of the phase 3 wave of the V1 lead QＲS form is lower than Chin J Diffic and Compl Cas，March 2023，Vol． 22，No． 3that of the atrial poor group，the Ｒ wave or qＲ or Ｒ of the V1 lead is greater than r，or the deepest rS is greater than 60 ms，the QＲS wave of the aVＲ lead has a sudden setback or a slow decline or a large Ｒ，the aVＲ lead Vi / Vt ≥ 1，and the propor-tion of the electric axis in the unmanned area is higher than that of the atrial poor group( χ2 / P = 15． 061 / ＜ 0． 001，48． 035 / ＜0． 001，29． 697 / ＜ 0． 001，31． 926 / ＜ 0． 001，61． 464 / ＜ 0． 001，45． 286 / ＜ 0． 001，4． 034 /0． 045) ． Among the quantitative indi-cators，the ratio of quasi-compensation interval / synrhythmic interval and quasi-compensation interval / pre-interval in the atrialpremature group was higher than that in the atrial differential group ( t / P = 9． 165 / ＜ 0． 001，29． 015 / ＜ 0． 001) ，while the ra-tio of pre-interval / synrhythmic interval was lower than that in the atrial differential group ( t / P = 18． 907 / ＜ 0． 001) ． The ＲOCcurve showed that the AUC for distinguishing atrial fibrillation with wide QＲS wave was 0． 865，0． 688，0． 934 and 0． 944 re-spectively in the pre-interval / synrhythmic period，quasi-compensational interval / synrhythmic period，quasi-compensational in-terval / synrhythmic period and the combination of the three，and the combined predictive value of the three was higher than thesingle quantitative index ( Z / P = 7． 796 / ＜ 0． 001，12． 633 / ＜ 0． 001，3． 061 /0． 002) ． Conclusion The combination of the three quantitative indicators and the quasi-compensation interval / pre-interval have good diagnostic value，which can provide an important reference for the differentiation of atrial fibrillation with ventricular premature and ventricular differential transmis-sion．

【Key words】 Atrial fibrillation; Premature ventricular contraction; Wide QＲS waves; Aberrant ventricular conduc-
tion; Quantitative indicators