Related Experiment Video
Updated: Mar 23, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Prolonged atrial refractoriness predicts the onset of atrial fibrillation: A 12-year follow-up study
Jung Myung Lee1, Hancheol Lee2, Ajit H Janardhan3
1Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Yonsei University College of Medicine, Seoul, South Korea.
Insights
A longer atrial effective refractory period (AERP) is linked to a higher risk of developing atrial fibrillation (AF). An AERP of 280 ms or more predicts increased future AF risk, especially in older individuals.
Area of Science:
- Electrophysiology
- Cardiology
- Medical Research
Background:
- Tissue refractoriness is key to fibrillation susceptibility.
- The link between atrial refractoriness and future atrial fibrillation (AF) is not well understood.
Purpose of the Study:
- To determine if atrial effective refractory period (AERP) predicts AF occurrence in a healthy population.
Main Methods:
- 1308 patients without heart disease underwent electrophysiology studies.
- Follow-up averaged 12 years to track new-onset AF.
Main Results:
- AERP increased with age.
- A baseline AERP ≥280 ms was associated with new-onset AF (HR 2.08, P = .041).
- Age also predicted AF development.
Conclusions:
- AERP increases with age.
- An AERP of ≥280 ms predicts a significantly higher future risk of developing AF.
Background:
Tissue refractoriness to conduction is a crucial electrophysiological factor in determining susceptibility to fibrillation. The relationship between atrial refractoriness and future onset of atrial fibrillation (AF) has not been well studied.
Objectives:
We investigated whether atrial effective refractory period (AERP) was associated with AF occurrence in a relatively healthy population.
Methods:
A total of 1308 patients with no overt structural heart diseases and no evidence of congestive heart failure who underwent electrophysiology studies for paroxysmal supraventricular tachycardia from January 1986 to January 2011 were included in the study (626 male, mean age 44 ± 16 years).
Results:
AERP increased with increasing age. Over a mean follow-up of 12 years, 51 of 1308 subjects (3.9%) developed AF. In univariate analysis, baseline AERP ≥280 ms (hazard ratio [HR] 2.54, 95% confidence interval [CI] 1.27-5.07, P = .008) was strongly associated with new-onset AF. In multivariate Cox regression analysis, age (adjusted HR 1.40 per 10 years, 95% CI 1.15-1.70, P = .001) and AERP ≥280 ms (adjusted HR 2.08, 95% CI 1.03-4.21, P = .041) were associated with new-onset AF. Kaplan-Meier AF-free survival curves demonstrated that subjects with an AERP of ≥280 ms had significantly lower AF-free survival compared those with AERP of <280 ms.
Conclusions:
AERP increases with age and AERP of ≥280 ms was predictive of patients at significantly increased future risk of developing AF.
Related Concept Videos
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:29Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow heart...
01:18Dysrhythmias IV: Characteristics of Bradyarrhythmias
01:15Aortic Regurgitation I: Introduction
01:23Rheumatic Heart Disease I: Introduction
01:28Mechanism of Cardiac Arrhythmias