Factors to Predict Recurrence of Atrial Fibrillation in Patients with Hypertension

Abstract

Backgound: Patients with essential hypertension had a higher recurrence rate of atrial fibrillation (AF) than patients without hypertension. This study evaluated the role of various parameters for predicting recurrence after conversion of AF in patients with essential hypertension. Methods: We retrospectively analyzed 136 patients with essential hypertension and a known history of AF. P-wave duration and dispersion were measured in a 12-lead electrocardiograph. The size and function of the left atrium (LA) and left atrial appendage (LAA) were assessed by transthoracic and transesophageal echocardiography. The time interval from initiation of P-wave to the start of LAA ejection flow (P-LAA) was measured at the same time. All the patients were followed up for a period of 12±6 months for the recurrence of AF. Results: In the follow-up period, 38.2%of patients underwent AF recurrence. Age, P-LAA, P max , P-wave dispersion, left atrium diameter (LAD), and maximum and minimum LAA volume were significantly higher in patients with AF recurrence than in patients without AF recurrence, while EF-LAA and LAA peak emptying velocity were much lower in patients with AF recurrence. P-LAA had positive correlation with LAD and P-wave dispersion (r = 0.501, p<0.0001; r = 0.713, p<0.0001). Conclusion: These results indicated that increased P-wave dispersion, P-LAA in addition to the dilated LA, and the depressed LAA function may be useful to identify patients with hypertension at risk of recurrent AF. IntroductionAtrial fibrillation (AF) is a common arrhythmia and is associated with an increased risk of thromboembolism. In the Framingham Heart Study, hypertension and diabetes were the sole cardiovascular risk factors that predicted AF after controlling for age and other predisposing conditions. 1 It is important to assess the risk of recurrent atrial fibrillation in hypertensive patients since hypertension is a common disorder predisposing to AF. In the Manitoba Follow-up study, prevalence of hypertension was 53%, and the risk of AF was 1.42 times higher in hypertensive subjects as compared with normotensive subjects. 2 However, despite its leading importance as a highly prevalent risk factor, there is little data available regarding predictors of recurrent AF in people with essential hypertension free of coexisting valvular or coronary heart disease, congestive heart failure, hyperthyroidism, or other predisposing conditions. In our study, we sought to determine if patients with hypertension and history of AF who are at risk of AF recurrence can be identified while in sinus rhythm by measurements of P-wave dispersion, P-LAA, and left atrial appendage function.

Atrial Fibrillation and Beta Thalassemia Major: The Predictive Role of the 12-lead Electrocardiogram Analysis

“…PD has been studied in some other conditions such as hypertension [29], obesity [30], diabetes mellitus [31], metabolic syndrome [32], dilated cardiomyopathy [33], myocardial infarction [34], atrial septal defect [35], hypertrophic cardiomyopathy [36], obstructive sleep apnea [37], Emery Dreifuss muscular dystrophy [38] and Wilson's disease [39]. The exact mechanism of PD prolongation in these clinical conditions is not well known, but it is thought that structural and electrophysiological changes in the atrial myocardium caused by elevated plasma volume [40], ventricular diastolic dysfunction [41] and enhanced neurohormonal activation [42], typical conditions of these deseases, may contribute to left atrial enlargement and electrical instability.…”

Early electrocardiographic evaluation of atrial fibrillation risk in beta-thalassemia major patients

“…PD is a noninvasive indicator of intra-atrial conduction heterogeneity producing substrate for reentry, which is a pathophysiological mechanism of atrial fibrillation [16,17]. PD has been studied in some other conditions such as hypertension [18], obesity [19], diabetes mellitus [20], metabolic syndrome [21], dilated cardiomyopathy [22], myocardial infarction [23], atrial septal defect [24], hypertrophic cardiomyopathy [25], obstructive sleep apnea [26] and Wilson's disease [27]. The exact mechanism of PD prolongation in these clinical conditions is not well known, but it is thought that structural and electrophysiological changes in the atrial myocardium caused by elevated plasma volume [28], ventricular diastolic dysfunction [29] and enhanced neurohormonal activation [30], that accompany these diseases, may contribute to left atrial enlargement and electrical instability.…”

Atrial Septal Aneurysms and Supraventricular Arrhythmias: The Role of Atrial Electromechanical Delay

“…The LA maximum volume (V max ) at the end‐systolic phase, LA minimum volume (V min ) at the end‐diastolic phase, and LA volume before atrial systole (V p ) (origin of P‐wave in electrocardiography) were measured, and all volumes were indexed to body surface area (BSA) and expressed in mL/m 2 . Parameters of LA function were calculated as follows: LA passive emptying volume (LAPEV): V max − V p ; LA passive emptying fraction (LAPEF): [(V max − V p )/V max ] × 100; LA active emptying volume (LAAEV): V p − V min ; LA active emptying fraction (LAAEF): [(V p − V min )/V p ] × 100; LA total emptying volume (LATEV): V max − V min ; LA ejection fraction (LAEF): [(V max − V min )/V max ] × 100 …”