RISK STRATIFICATION FOR RECURRENT TACHYARRHYTHMIAS IN PATIENTS WITH PAROXYSMAL ATRIAL-FIBRILLATION AND FLUTTER - ROLE OF SIGNAL-AVERAGED ELECTROCARDIOGRAM AND ECHOCARDIOGRAPHY

The value of signal-averaged P-wave electrocardiogram a?ld echocardiog raphy for predicting recurrent atrial tachyarrhythmias was prospective ly investigated in 60 patients presenting with paroxysmal atrial fibri llation or flutter.: AII patients were followed up for I year after re storation of sinus rhythm. A stepwise discriminant function? analysis was used to identify variables predicting recurrent atrial tachyarrhyt hmias. Analyzed I,variables included signal-averaged P-wave duration i n 3 bipolar orthogonal leads (X,Y,Z) and their vector magnitude. as we ll as left and right atrial dimensions and? volumes. During follow-up, 25 patients had recurrent atrial tachyarrhythmias, while 35 did not. Using discriminant function analysis, the left atrial antero-superior dimension was found to be the only variable predicting the recurrence of atrial tachyarrhythmias (p<0.0038) and was able to correctly classi fy 65% of the study patients. It was concluded that, in patients with paroxysmal atrial fibrillation of flutter, the traditionally used dete rmination of left atrial dimension was the variable most closely assoc iated with a high risk for recurrent tachyarrhythmias. The signal-aver aged P-wave duration did not improve tachyarrhythmia prediction.