Prediction of atrial fibrillation with atrial late potentials and pathological chemoreflexsensitivity

Atrial fibrillation (AF) is a very common arrhythmia that often causes the serious complication of a stroke.

The aim was to evaluate the utility of pathological chemoreflexsensitivity (PCHRS) and atrial late potentials (ALP) to predict AF in follow-up.

We investigated a prospective study on the basis of our observation about a PCHRS and ALP in paroxysmal AF. The PCHRS was predefined as a chemoreflexsensitivity below 3.0 ms/mmHg and ALP were predefined as a filtered P-wave duration > or =120 ms and a root mean square voltage of the last 20 ms of the P-wave < or =3.5 microV. A P-wave triggered P-wave signal averaged electrocardiograph (ECG) and chemoreflexsensitivity was performed on 250 consecutive patients who were divided into four groups. Group I consisted of patients with ALP and PCHRS, patients of group II had only ALP, a PCHRS was only present in group III, and patients of group IV had neither ALP nor PCHRS.

During the mean follow-up of 37.8 months AF was observed in 10 patients (4%). The patients of the four groups were similar according to clinical baseline characteristics. The incidence of AF was higher in group I (18% of patients) than in group II (6% of patients, P = 0.229) and significantly higher than in group III (3% of patients, P = 0.034) or group IV (1% of patients, P < 0.0001). Patients with ALP and PCHRS showed a 33-fold risk (P < 0.001) for the onset AF.

The results of our study suggest that the probability of AF could be predicted with a P-wave signal averaged ECG and an analysis of chemoreflexsensitivity. The predictive power of the combination of ALP and PCHRS seemed not high enough for risk stratification.