Prediction of Conversion from Paroxysmal to Permanent Atrial Fibrillation
Article first published online: 28 FEB 2007
Pacing and Clinical Electrophysiology
Volume 30, Issue 2, pages 243–252, February 2007
How to Cite
BUDEUS, M., FELIX, O., HENNERSDORF, M., WIENEKE, H., ERBEL, R. and SACK, S. (2007), Prediction of Conversion from Paroxysmal to Permanent Atrial Fibrillation. Pacing and Clinical Electrophysiology, 30: 243–252. doi: 10.1111/j.1540-8159.2007.00656.x
- Issue published online: 28 FEB 2007
- Article first published online: 28 FEB 2007
- Received August 29, 2006; revised October 11, 2006; accepted October 26, 2006.
- P wave signal averaged ECG;
- permanent atrial fibrillation;
- paroxysmal atrial fibrillation
Background: Paroxysmal atrial fibrillation (PAF) transits to permanent atrial fibrillation (PEAF). The current study was to determine whether a P wave-triggered P wave signal averaged electrocardiogram (P-SAECG) and chemoreflexsensitivity (CHRS) are useful to predict a conversion to PEAF in patients with PAF.
Methods: The filtered P wave duration (FPD) and the root mean square voltage of the last 20 ms of the P wave (RMS 20) were measured by P-SAECG. The ratio between the difference of RR intervals in the ECG and venous pO2 before and after 5-minutes oxygen inhalation is measured (ms/mmHg) for the determination of CHRS.
Results: A total of 180 patients with PAF were enrolled and followed for a mean of 22.5 months. PEAF occurred in 38 patients (21%) and these patients had a significantly larger left atrial size (43.2 ± 4.9 vs. 41.0 ± 5.4 mm, P = 0.021), a significantly longer FPD (158.8 ± 18.2 vs. 136.7 ± 16.6 ms, P < 0.0001), and a significantly lower CHRS (1.96 ± 0.99 vs. 2.44 ± 1.19 ms/mmHg, P = 0.024) than patients with PAF. Patients with PEAF tended to have a lower RMS 20 (2.38 ± 0.65 vs. 2.75 ± 1.18 μV, P = 0.067) than patients with PAF. The χ2 test showed that the combination of FPD ≥ 145 ms, RMS 20 ≤3.0 μV, left atrial size ≥ 41 mm, and CHRS ≤2.0 ms/mmHg had the best predictive power for PEAF. Patients who fulfilled these criteria had a 12-fold increased risk for a conversion from PAF to PEAF.
Conclusions: 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.