Fibrillation cycle length predicts cardiovascular events in patients with long-standing persistent atrial fibrillation

• Published in: Heart and vessels 2022-06, Vol.37 (6), p.1027-1033
• Main Authors: Nakamura, Hironori, Niwano, Shinichi, Fukaya, Hidehira, Kishihara, Jun, Satoh, Akira, Oikawa, Jun, Yoshizawa, Tomoharu, Ishizue, Naruya, Igarashi, Tazuru, Fujiishi, Tamami, Nishinarita, Ryo, Horiguchi, Ai, Ako, Junya
• Format: Article
• Language: English
• Subjects: Biomedical Engineering and Bioengineering; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Cerebral infarction; Confidence intervals; Congestive heart failure; Death; EKG; Electrocardiography; End-stage renal disease; Fast Fourier transformations; Fibrillation; Fourier analysis; Health hazards; Hemodialysis; Ischemia; Kidney diseases; Medicine; Medicine & Public Health; Mortality; Multivariate analysis; Myocardial infarction; Original Article; Statistical models; Stroke; Thermal resistance; Transient ischemic attack; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-021-01993-x

Background Atrial fibrillation (AF) is associated with an increased risk of heart failure (HF), stroke, and death. Although fibrillation cycle length (FCL) is used as a surrogate for atrial refractoriness, its impact on outcomes remains unclear. This study aimed to identify predictors of cardiovascular events, including FCL, in patients with long-standing persistent AF. Methods The study included 190 consecutive patients with long-standing persistent AF (mean age 74 years, 74% male). Patients with valvular AF or hemodialysis-dependent end-stage renal disease and those on anti-arrhythmic drugs were excluded. The primary composite outcome was occurrence of cardiovascular events (myocardial infarction, HF), cerebrovascular events (stroke, transient ischemic attack), and all-cause death. FCL was calculated by fast Fourier transformation analysis of fibrillation waves in the surface electrocardiogram. Results Over a median follow-up of 2.6 years, the primary outcome occurred in 31 patients (cardiovascular events, n  = 18; cerebrovascular events, n  = 8; all-cause death, n  = 5). In multivariate analysis, longer FCL and history of HF were independent predictors of these outcomes. In a Cox proportional hazards model adjusted for age, sex, and history of HF, patients with an FCL > 160 ms (cut-off determined by receiver-operating characteristic curve analysis) were at increased risk of the outcome (hazard ratio 12.9; 95% confidence interval 4.99–44.10; p