Investigation of the predictors of transition to persistent atrial fibrillation in patients with paroxysmal atrial fibrillation

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2002-02, Vol.25 (2), p.69-75
• Main Authors: Koide, Yasushi, Yotsukura, Masayuki, Sakata, Konomi, Yoshino, Hideaki, Ishikawa, Kyozo
• Format: Article
• Language: English
• Subjects: Aged; Atrial Fibrillation - diagnosis; Atrial Fibrillation - pathology; Atrial Fibrillation - physiopathology; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Clinical Investigation; Clinical Investigations; Disease Progression; Electrocardiography; Female; filtered P‐wave duration; Heart; Humans; Male; Medical sciences; Middle Aged; persistent atrial fibrillation; Predictive Value of Tests; predictors; Prognosis; Prospective Studies; Risk Factors; Sensitivity and Specificity; Severity of Illness Index
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4950250206

Background: Until now, no clinically useful indicators have existed that predict the transition from paroxysmal to persistent atrial fibrillation (AF). Hypothesis: The current prospective study was conducted for identifying predictors of progression to persistent AF over the long term. Methods: We studied 102 consecutive patients (mean age: 55 ± 10 years; 75 men and 27 women) diagnosed with paroxysmal AF. Standard 12‐lead electrocardiography, echocardiography, and P‐wave‐triggered signal‐averaged electrocardiography (P‐SAECG) were performed on all patients at the time of their entry into the study. Results: The mean follow‐up period was 61 ± 13 months. Group 1 (n = 66) comprised patients in whom paroxysmal AF did not progress to persistent AF, and Group 2 (n = 36) comprised those who developed persistent AF. In Group 2 the patients were significantly older, and P‐wave dispersion, filtered P‐wave duration (FPD), and left atrial dimension were significantly higher than in Group 1 (p < 0.05). The root mean square voltage for the last 30 ms of the filtered P‐wave was also significantly lower in Group 2 (p < 0.05). Multivariate logistic regression analysis using these five factors identified left atrial dimension (odds ratio [OR] 2.29; 95% confidence interval [CI] 1.16‐4.54; p = 0.02) and FPD (OR 2.71; 95% CI 1.78‐ 4.13; p< 0.01) as independent predictors of transition to persistent AF. Left atrial dimension ≤ 40 mm predicted progression to persistent AF with a sensitivity of 64%, specificity of 76%, positive predictive value of 59%, negative predictive value of 79%, and an accuracy of 71%. An FPD ≤ 150 ms predicted persistent AF with a sensitivity of 81%, specificity of 91%, positive predictive value of 88%, negative predictive value of 90%, and an accuracy of 87%. Filtered P‐wave duration was a significantly more sensitive and specific predictor than left atrial dimension (p < 0.05). Conclusion: We conclude that FPD is a clinically useful predictor of progression from paroxysmal to persistent AF over the long term.