Prediction of Conversion from Paroxysmal to Permanent Atrial Fibrillation

Budeus, Marco; Felix, Oliver; Hennersdorf, M.; Wieneke, Heinrich; Erbel, Raimund; Sack, Stefan

doi:10.1111/j.1540-8159.2007.00656.x

Cited by 20 publications

(17 citation statements)

References 27 publications

(98 reference statements)

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“…In this study, during an average follow-up period of 28 (23) months, eight patients (21.6%) with non-valvular PAF developed CAF. The probability of progression to CAF (permanent AF) has been reported to be about 8.6% after 1 year, 21% after 2 years and 24.7% after 5 years in PAF patients, which is consistent with our results made on a standard ECG or 24 h Holter ECG,4 31 though such a 7-day Holter ECG would have been a more robust method, if possible in our patients. Several echocardiographic and electrocardiographic parameters were investigated as predictors of AF, but it still remains difficult to predict progression from PAF to CAF 4 – 9…”

Section: Discussionsupporting

confidence: 92%

Interatrial dyssynchrony on tissue Doppler imaging predicts progression to chronic atrial fibrillation in patients with non-valvular paroxysmal atrial fibrillation

Sakabe

Fukuda

et al. 2009

Heart

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Section: Discussionsupporting

confidence: 92%

Interatrial dyssynchrony on tissue Doppler imaging predicts progression to chronic atrial fibrillation in patients with non-valvular paroxysmal atrial fibrillation

Sakabe

Fukuda

et al. 2009

Heart

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“…24,25 On the basis of the general concept that an enlarged atria causes broad P-waves on a standard ECG, several studies have focused on the influence of atrial size on the P-wave duration in patients with or without AF, but the results are conflicting. Budeus et al have reported a significant positive correlation between FPD and atrial size (r=0.57, P=0.001) in patients with paroxysmal AF, 26 whereas Ishimoto et al did not observe a significant correlation between FPD and atrial volume, which was measured by cine magnetic resonance imaging, in patients with paroxysmal AF. 23 Chalfoun et al demonstrated a strong correlation between FPD and atrial size in patients who remained in sinus rhythm (R 2 = 0.67, P=0.003), but not in those who returned to AF (R 2 = 0.11, P=0.65) after electrical cardioversion for persistent AF, and they suggested that the lack of correlation between atrial size and FPD in those who reverted back to AF might be related to electromechanical dissociation in their atria.…”

Section: Discussionmentioning

confidence: 94%

Impact of Obstructive Sleep Apnea on the Atrial Electromechanical Activation Time

Lim

Kim

et al. 2009

Circ J

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Background Obstructive sleep apnea (OSA) is closely associated with atrial fibrillation, which is provoked by electrical and structural remodeling. However, the association between OSA and atrial remodeling has not been fully elucidated. Methods and ResultsAtrial electromechanical activation time (EMAT) was investigated using tissue Doppler imaging (TDI) in men with severe OSA (n=24) and control subjects (n=24). The EMAT was determined as the time interval from the initiation of P-wave deflection until the peak of local lateral left atrial (LA) TDI signal. The early diastolic velocity of the mitral annulus (Ea) and the EMAT were significantly lower and longer in OSA cases than in controls (Ea: 6.1±0.9 cm/s vs 7.3±1.5 cm/s, P=0.001; EMAT: 129.7±11.5 ms vs 118.5±12.3 ms, P=0.002). Among OSA cases, the apnea -hypopnea index (AHI) was significantly correlated with EMAT (r=0.660, P<0.001), Ea (r=-0.609, P=0.002), LA dimension (r=0.486, P=0.016), and early diastolic velocity of mitral flow (E)/Ea ratio (r=0.418, P=0.042). In multivariate stepwise linear regression analysis, EMAT was independently associated with AHI (P=0.025) and Ea (P=0.028) in OSA cases. Conclusion EMAT measured by TDI could be a useful parameter for identifying atrial remodeling in patients with severe OSA. (Circ J 2009; 73: 249 -255)

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“…Applications of SAECG are similar to P wave indices’ described above. Prolonged P wave SAECGs have been associated with recurrence of AF following cardioversion;50 comparison of hypertensive subjects with paroxysmal AF and those without;51 AF following cardiothoracic surgery;52;53 and transition from paroxysmal to permanent AF 54. Advantages of SAECG include its incorporation of information from hundreds of data points and lack of reliance on distinguishing P wave on-set and off-set, which improve the reliability and accuracy of the technique.…”

Section: Signal Average Ecgmentioning

confidence: 99%

P Wave Indices

Magnani

Williamson

Ellinor

et al. 2009

Circ: Arrhythmia and Electrophysiology

106

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O ur review describes the current field of P wave indices. We report the methodology for determining P wave indices. We also describe the strengths and limitations of the current literature on the clinical correlates and prognosis of P wave indices. We suggest future clinical and research directions for P wave indices.The P wave indices of maximum duration and dispersion have received increasing attention and have been examined in a broad range of clinical settings. The ECG, as a vectorcardiogram, 1 quantifies the magnitude and direction of electric propagation and depolarization. Insults such as chronically elevated atrial pressure, ischemia, and metabolic stress lead to atrial remodeling marked by inflammation, fibrosis and poor cellular coupling. The electrophysiological result is slowed conduction with inhomogeneous recovery, defining a substrate for atrial fibrillation (AF). 2 Investigators hypothesize that P wave prolongation is an intermediate step in the accumulation of insults ultimately leading to AF. Thus, initial studies sought to demonstrate significant differences between samples with a history of AF and healthy referents, arguing that prolonged P wave duration and dispersion predict recurrent AF. Further studies have used P wave indices to compare multiple samples with and without cardiac diseases. The most recent iteration of studies has extended use of P wave indices beyond cardiac pathology to distinguish a variety of disease entities and comparison groups; the wide array of disease samples studied is listed in Table 1. Given such broad clinical applications, automated reporting of the P wave duration in electrocardiographic measurement for screening purposes has been advocated. 41 The variety of studies has resulted in varying methodologies and yielded conflicting results. Many areas in P wave indices research remain uncertain, including their clinical correlates and distribution in the community, and the extent to which P wave indices are associated with AF, predict its occurrence, are heritable phenotypes, or serve as biomarkers of other cardiovascular insults. The present review was undertaken to assess the current evidence for use of P wave indices with attention toward study design, strengths, and remaining questions surrounding their clinical application. Literature Search MethodsWe conducted a literature search of PubMed and OVID databases to identify articles published from January 1985 to December 2007. We searched using the Medical Subject Headings and key words of P wave dispersion, P wave indices, dispersion, AF, and ECG, both separately and together with predict and prediction. We reviewed reference lists of retrieved articles to identify additional publications for inclusion. Because of the volume of research in this area and the duplicative nature of the field's research, we excluded studies with less than 100 subjects unless they described a novel clinical application of P wave indices. Studies were described as cohort, case control, or cross-sectional. Case reports, scientific...

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Prediction of Conversion from Paroxysmal to Permanent Atrial Fibrillation

Abstract: Our results show that a P-SAECG, an analysis of CHRS, and left atrial enlargement are clinical predictors of a progression from PAF to PEAF.

Cited by 20 publications

References 27 publications

Interatrial dyssynchrony on tissue Doppler imaging predicts progression to chronic atrial fibrillation in patients with non-valvular paroxysmal atrial fibrillation

Interatrial dyssynchrony on tissue Doppler imaging predicts progression to chronic atrial fibrillation in patients with non-valvular paroxysmal atrial fibrillation

Impact of Obstructive Sleep Apnea on the Atrial Electromechanical Activation Time

P Wave Indices

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