A noninvasive index of atrial remodeling in patients with paroxysmal and persistent atrial fibrillation: a pilot study

作者：Vincenti Antonio; Rota Matte; Spinelli Monica; Corciulo Mariella; De Ceglia Sergio; Rovaris Giovanni; Antolini Laura; Genovesi Simonetta^*

来源：Journal of Electrocardiology, 2012, 45(2): 109-115.

DOI：10.1016/j.jelectrocard.2011.08.005

• Paroxysmal atrial fibrillation
• Persistent atrial fibrillation
• Signal-averaged P-wave duration
• Atrial diameter
• Atrial remodeling
• Remodeling index

Purpose: This study aims to develop a noninvasive atrial remodeling index (RI) to separate patients presenting paroxysmal atrial fibrillation (ParAF) from those with sustained persistent atrial fibrillation (PerAF), that is, AF episodes interrupted 7 days or more after the onset. %26lt;br%26gt;Methods: Signal-averaged P-wave duration (SAPWd) and left atrial anteroposterior diameter (LADd) were measured in 33 ParAF patients, in 26 sustained PerAF patients, and in 18 control subjects. By using SAPWd and LADd, a dichotomous (0/1) RI was created. A logistic regression model on the probability of having a sustained PerAF vs a ParAF episode was estimated, including the RI, sex, age, and cardiac comorbidities as covariates. %26lt;br%26gt;Results: Signal-averaged P-wave duration was significantly longer in sustained PerAF (153 +/- 15 milliseconds) than in ParAF patients (142 +/- 13 milliseconds, P %26lt;.001) and in both ParAF and sustained PerAF groups vs control group (123 +/- 7 milliseconds, P %26lt;.001). Left atrial anteroposterior diameter was larger both in sustained PerAF (43 +/- 6 mm) vs ParAF patients (38 5 mm, P=.002) and in sustained PerAF group vs control group (38 +/- 2 mm, P=.004), but no differences were observed between ParAF patients and controls (P=.6). A 12-fold increase (odds ratio, 11.8; 95% confidence interval, 2.2-63.5) in the odds of having a sustained PerAF vs a ParAF episode was observed in patients with RI equal to 1. %26lt;br%26gt;Conclusions: P-wave duration and left atrium diameter enabled to define a noninvasive atrial RI to separate patients with ParAF from those with sustained PerAE. This could be a useful tool to select a suitable strategy for AF treatment.

• 出版日期2012-4