Prediction of paroxysmal atrial fibrillation in patients with congestive heart failure: A prospective study

OBJECTIVES We sought to prospectively determine whether patients with conge stive heart failure (CHF) at risk for paroxysmal atrial fibrillation (PAF) could be identified by clinical and study variables including the P-wave si gnal-averaged electrocardiogram (P-SAECG). BACKGROUND Although it is important to assess the risk of developing PAF in patients with CHF, it still remains difficult to predict the PAF appearanc e in patients with CHF clinically. METHODS The study group consisted of 75 patients in sinus rhythm without a history of PAF, whose left ventricular ejection fraction, as measured by ra dionuclide angiography, was <40%. These patients underwent P-SAECG, echocar diography and 24-h Holter monitoring; in addition, the plasma concentration of atrial natriuretic peptide (ANP) was measured at study entry. RESULTS An abnormal P-SAECG was found at study entry in 29 of 75 patients. In the follow-up period of 21 +/- 9 months, the PAF attacks documented on t he ECG significantly more frequently occurred in patients with (32%) rather than without an abnormal P-SAECG (2%) (p = 0.0002). The plasma ANP level w as significantly higher in patients with rather than without PAF attacks (7 5 +/- 41 vs. 54 +/- 60 pg/ml, p = 0.01), although there were no significant differences in age, left atrial dimension Or high grade atrial premature b eats between the groups. The multivariate Cox analysis identified that the variables significantly associated with PAF development were an abnormal P- SAECG (hazard ratio 19.1, p = 0.0069) and elevated ANP level greater than o r equal to 60 pg/ml (hazard ratio 8.6, p = 0.018). CONCLUSIONS An abnormal P-SAECC and elevated ANP level could be predictors of PAF development in patients with CHF. (J Am Coil Cardiol 2000;35:405-13) (C) 2000 by the American College of Cardiology.