Indicators of structural and electrical atrial remodeling in predicting the risk of ventricular tachyarrhythmia in patients with chronic heart failure

Objective. To estimate predictive value of indicators of structural and electrical atrial remodeling in predicting the risk of ventricular tachyarrhythmia (VT) in patients with chronic heart failure (HF), left ventricular ejection fraction (LV EF) ≤35% and sinus rhythm. Material and methods. A single-center prospective study included 342 HF patients without syncope or sustained VT undergoing implantation of cardioverter-defibrillator for primary prevention of sudden cardiac death (SCD). Patients underwent standard examination, including electrocardiography and transthoracic echocardiography. We analyzed linear and volumetric ultrasonic characteristics of the atria, duration and shape of P wave. Patients were followed-up for 2 years regarding VT. The last one included both ventricular tachycardia and ventricular flutter/fibrillation. The primary endpoint was either first-time sustained VT (≥ 30 seconds) detected in «monitor» area or VT with cardioversion. Results. The primary endpoint was recorded in 98 patients (29%). All groups were comparable in major characteristics. Two factors with the highest predictive potential regarding the endpoint (p<0.1) were used for multivariate analysis: « P wave duration in lead II >120 ms» (OR 3.1; 95% CI 1.25—7.49; p=0.014) and «superoinferior size of left atrium >6 cm» (OR 1.9; 95% CI 0.96—3.78; p=0.065). Appropriate predictive model had sensitivity and specificity of 14.3% and 96.7%, respectively. P wave duration in lead II >120 ms is an independent predictor of study endpoint. Conclusion. Our results indicate advisability of ECG and echocardiography parameters of the atria in multivariate predictive models for analysis of SCD risk in patients with HF and reduced LV EF.