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Prediction of paroxysmal atrial fibrillation in patients with congestive heart failure: a prospective study
T Yamada1, M Fukunami, T Shimonagata
1Division of Cardiology, Osaka Prefectural General Hospital, Japan.
Insights
Identifying paroxysmal atrial fibrillation (PAF) in congestive heart failure (CHF) patients is challenging. An abnormal P-wave signal-averaged electrocardiogram (P-SAECG) and elevated atrial natriuretic peptide (ANP) levels can predict PAF development in these patients.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Predicting paroxysmal atrial fibrillation (PAF) in congestive heart failure (CHF) patients remains clinically difficult.
- Early identification of at-risk individuals is crucial for timely intervention and management.
Purpose of the Study:
- To prospectively identify patients with CHF at risk for developing PAF.
- To evaluate the utility of the P-wave signal-averaged electrocardiogram (P-SAECG) and plasma atrial natriuretic peptide (ANP) levels as predictive markers.
Main Methods:
- A cohort of 75 CHF patients in sinus rhythm with ejection fraction <40% was studied.
- Patients underwent P-SAECG, echocardiography, 24-h Holter monitoring, and plasma ANP measurement.
- Follow-up was conducted for approximately 21 months to document PAF development.
Main Results:
- An abnormal P-SAECG was detected in 29% of patients at baseline.
- PAF developed in 32% of patients with abnormal P-SAECG versus 2% without (p=0.0002).
- Elevated ANP levels were significantly higher in patients who developed PAF. Multivariate analysis identified abnormal P-SAECG (HR 19.1) and ANP ≥60 pg/ml (HR 8.6) as significant predictors.
Conclusions:
- An abnormal P-SAECG is a strong predictor of future PAF development in CHF patients.
- Elevated plasma ANP levels also indicate an increased risk for PAF in this population.
- Combined assessment of P-SAECG and ANP may improve risk stratification for PAF in CHF.
Objectives:
We sought to prospectively determine whether patients with congestive heart failure (CHF) at risk for paroxysmal atrial fibrillation (PAF) could be identified by clinical and study variables including the P-wave signal-averaged electrocardiogram (P-SAECG).
Background:
Although it is important to assess the risk of developing PAF in patients with CHF, it still remains difficult to predict the PAF appearance in patients with CHF clinically.
Methods:
The study group consisted of 75 patients in sinus rhythm without a history of PAF, whose left ventricular ejection fraction, as measured by radionuclide angiography, was <40%. These patients underwent P-SAECG, echocardiography and 24-h Holter monitoring; in addition, the plasma concentration of atrial natriuretic peptide (ANP) was measured at study entry.
Results:
An abnormal P-SAECG was found at study entry in 29 of 75 patients. In the follow-up period of 21 +/- 9 months, the PAF attacks documented on the ECG significantly more frequently occurred in patients with (32%) rather than without an abnormal P-SAECG (2%) (p = 0.0002). The plasma ANP level was significantly higher in patients with rather than without PAF attacks (75 +/- 41 vs. 54 +/- 60 pg/ml, p = 0.01), although there were no significant differences in age, left atrial dimension or high grade atrial premature beats between the groups. The multivariate Cox analysis identified that the variables significantly associated with PAF development were an abnormal P-SAECG (hazard ratio 19.1, p = 0.0069) and elevated ANP level > or =60 pg/ml (hazard ratio 8.6, p = 0.018).
Conclusions:
An abnormal P-SAECG and elevated ANP level could be predictors of PAF development in patients with CHF.
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