Investigation of the predictors of transition to persistent atrial fibrillation in patients with paroxysmal atrial fibrillation

Abstract

SummaryBackground: Until now, no clinically useful indicators have existed that predict the transition from paroxysmal to persistent atrial fibrillation (AF).Hypothesis: The current prospective study was conducted for identifying predictors of progression to persistent AF over the long term.Methods: We studied 102 consecutive patients (mean age: 55 ± 10 years; 75 men and 27 women) diagnosed with paroxysmal AF. Standard 12-lead electrocardiography, echocardiography, and P-wave-triggered signal-averaged electrocardiography (P-SAECG) were performed on all patients at the time of their entry into the study.Results: The mean follow-up period was 61 ± 13 months. Group 1 (n = 66) comprised patients in whom paroxysmal AF did not progress to persistent AF, and Group 2 (n = 36) comprised those who developed persistent AF. In Group 2 the patients were significantly older, and P-wave dispersion, filtered P-wave duration (FPD), and left atrial dimension were significantly higher than in Group 1 (p < 0.05). The root mean square voltage for the last 30 ms of the filtered P-wave was also significantly lower in Group 2 (p < 0.05). Multivariate logistic regression analysis using these five factors identified left atrial dimension (odds ratio [OR] 2.29; 95% confidence interval [CI] 1.16-4.54; p = 0.02) and FPD (OR 2.71; 95% CI 1.78-4.13; p<0.01) as independent predictors of transition to persistent AF. Left atrial dimension ≥ 40 mm predicted progression

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

“…19) Similarly, they reported that such AF progression can be detected by LA enlargement with a sensitivity of 64%, specificity of 76%, positive predictive value of 59%, and negative predic- tive value of 79%. 18) In the present study, although we identified P wave dispersion and LAD as independent predictive factors for discrimination between PAF and persistent AF patients, the sensitivity and specificity of each parameter for PAF and/or persistent AF discrimination were limited (Table III). However, combination of both parameters achieved very high sensitivity and specificity, which may be useful for distinguishing PAF from persistent AF patients in clinical practice.…”

“…18,[27][28][29] However, the underlying cause of LA enlargement may be more complicated than the above explanation. Because we selected "new-onset AF" patients in the present study, LA enlargement may not only be due to AF, but may also be influenced by other underlying conditions.…”

“…Several studies have reported the importance of P wave dispersion as a marker of the clinical phase of AF, [18][19][20] suggesting that P wave dispersion may be prolonged with progression of the AF phase, ie, the change from the PAF to persistent AF phase. Furthermore, Koide, et al concluded that P wave dispersion measurement may be useful in determining the progression of the clinical phase of AF.…”

Volumetric Cine CMR to Quantify Atrial Structure and Function in Patients with Atrial Dysrhythmias

“…Koide et al found that filtered P-wave duration with signal-averaged electrocardiography was significantly more sensitive and specific than echocardiographically-determined left atrial dimension as a predictor of progress of PAF to chronic AF (19). We are also performing ongoing studies assessing for ventricular myopathy with delayed myocardial enhancement (DME) acquisitions, which may reveal midmyocardial fibrosis that has previously been described only at autopsy in HCCMD members; normal ventricular function in the early affected cohort evaluated in this study makes significant myocardial fibrosis at this stage less likely.…”

Prevalence and Prognosis of Patients With Atrial Fibrillation in Japan

“…Paroxysmal AF has been reported to develop to persistent AF at a rate of 7% per year in Western country 25 and 5.5-6.3% per year in Japan. 26,27 Consequently, it has been believed that the prognosis of AF patients becomes worse according to the progression of AF.…”