Discrimination of Paroxysmal and Persistent Atrial Fibrillation in Patients With New-Onset Atrial Fibrillation

Abstract

SummaryDiscrimination between paroxysmal and persistent atrial fibrillation (PAF and persistent AF) is important for determining the therapeutic strategy in patients with new-onset AF. We evaluated various clinical factors and P wave morphology to discriminate PAF and persistent AF patients in patients with new-onset AF.The study population consisted of 79 patients with new-onset AF (70.3 ± 10.8 years, female:male 33:46) who were retrospectively selected from 8,632 AF patients in the Kitasato University Hospital ECG storing system. PAF (n = 38) and persistent AF (n = 41) patients were diagnosed by whether the initial PAF episode continued for 1 week. The P wave morphologies were analyzed using the most recent 12 lead-ECG recording of sinus rhythm. P wave dispersion was defined as the difference between the maximum and minimum durations of all leads. Along with these data, various clinical factors were evaluated and compared between PAF and persistent AF patients.Multivariate analysis identified P wave dispersion (56.6 ± 14.8 versus 66.5 ± 12.8 msec, P = 0.002) and left atrial dimension (LAD: 40.2 ± 7.0 versus 47.7 ± 8.2 mm, P < 0.001) as independent factors for discrimination between PAF and persistent AF patients. Combining these two parameters achieved a specificity of 88.9%, a positive predictive value of 81.8%, a sensitivity of 95.3%, and a negative predictive value of 88.9%.In patients with new-onset AF, P wave dispersion and LAD were independent factors for discrimination between PAF and persistent AF. (Int Heart J 2016; 57: 573-579) Key words: P wave I n clinical practice, identification of the clinical stage of atrial fibrillation (AF) is an important issue to enable clinicians to determine a therapeutic strategy, especially in patients with new-onset AF, in whom it is important to determine the indication of antiarrhythmic agents or catheter ablation.1-3) When considering catheter ablation for AF, it is important to identify the early stage of AF, ie, paroxysmal atrial fibrillation (PAF), because the efficacy of catheter ablation is higher in PAF patients, and the ablation procedure itself can be simplified. 4,5) Recently, we have reported that P wave analysis in the 12-lead ECG of sinus rhythm is useful in determining the emergence of AF in clinical cases. 6) We have shown that the P wave amplitude in lead II or V1 was higher, and P wave dispersion, ie, the dispersion of P wave duration, was larger in patients with new-onset AF compared with control patients without AF.6) Therefore, we hypothesized that the clinical stage of AF may also be identified by P wave analysis, as well as with the other clinical parameters. In the present study, we retrospectively identified patients with new-onset AF in the digital ECG profiling system of our hospital. Patients were classified into PAF and persistent AF by their clinical course in accordance with the definitions in the AHA/ACC/ESC guidelines and JCS guidelines.7,8) P waves in the preceding sinus rhythm state were analyzed as the precursor state for new-onset ...

Impact of Sinus Node Recovery Time after Long-Standing Atrial Fibrillation Termination on the Long-Term Outcome of Catheter Ablation

“…1,2) Although the pathophysiological mechanism of AF is not completely understood, the progression of atrial remodeling in AF has been shown to contribute significantly to the perpetuation of AF. [3][4][5] Further, sinus node dysfunction (SND) occurs along with the presence of atrial remodeling in the upper part of the right atrium. 4) Therefore, we hypothesized that patients with AF who have impaired sinus node function would have a lower success rate of catheter ablation of AF and that the sinus node recovery time (SNRT) after defibrillation from a long period of AF could be used to predict recurrences of AF after ablation.…”

Beat-to-beat P-wave Variability Increases from Paroxysmal to Persistent Atrial Fibrillation

“…To our knowledge, few studies are present in literature about differences between paroxysmal and persistent AF in ECG parameters during SR [10], [13], [14], and none of these focus on beat-to-beat P-wave variability, taking into account also other possible sources of variability in ECG.…”

Sex-related electrocardiographic differences in patients with different types of atrial fibrillation: Results from the SWISS-AF study

“…The identification of the clinical stage of AF (pathology progression) and the discrimination between paroxysmal and persistent AF is of utmost importance while assessing the therapeutic strategy and subsequent outcomes. Nearly all previous studies have focused on the identification of AF susceptibility or have correlated P-wave morphology to prognosis, but only few studies have analyzed sex-related ECG differences among patients with different clinical types of AF in SR [30]. Differently from these studies, Swiss-AF cohort included patients with known paroxysmal and persistent AF.…”