Stratification of Hypertensive Patients According to Risk Score – Contribution to Prevention of Atrial Fibrillation?

Objective: AH patients with different disease duration and treatment with different CV risk were examined and followed longitudinally. The aim is risk stratification of patients, with regard to the developing atrial fibrillation (AF). Design and method: 284 patients (179 men, 105 women) were examined repeatedly: group 1 (n=133) with preserved LV function without paroxysmal AF, group 2 (n=130) with documented pAF, group 3 (n= 21) after radiofrequency ablation (RFA) for pAF/AFLA. All examined patients had sinus rhythm. NonECG data (clinical, laboratory data, echoCG, ABPM), ECG parameters (ECG, Holter ECG, VKG, high-resolution ECG, i.e. late ventricular potentials-LVPs. late atrial potentials-LAPs) were monitored. Results: Groups 1,2,3 did not differ significantly in BMI and monitored echoGG parameters. The differences between groups 1 and 2 was statistically significant in following parameters: non-dippers in ABPM, verified CHD, 3 or more combinations of drugs. In ECG parameters: abnormal LVPs and LAPs increased significantly between groups 1, 2 and 3. For LVPs: abnormal fQRSd (n, %) group 1: 61 (35.9), group 2: 71 (54.6), group 3: 17 (81.0), p<0.01. For LAPs: abnormal fPd (n, %) group 1: 93 (69.9), group 2: 113 (86.9), group 3: 20 (95.5), p<0.001. For the presence of high abnormal nPd+fPd (n, %): group 1: 89 (66.9), group 2: 106 (81.5), group 3: 21 (100.0), p<0.001. We created score system of 14 points: 0-7 points for non-ECG and 0-7 points for ECG, VCG and hrECG. Conclusions: Based of these parameters and the longitudinal monitoring we proposed an available scoring system to assess the risk of developing pAF, as a serious complication of AH: 7 nonECG and 7 ECG parameters). 7 non-ECG parameters in the score: (1) age >60 years, (2) BMI >30, (3) DM, (4) HLP, (5) CHD, (6) post-CABG status, (7) non-dipper in ABPM. 7 ECG parameters in the score: (1) Holter ECG with ESVEA <500 SVEA, (2) VCG QRS loop axis <15° (normal 18–25°), (3) abnormal fQRSd duration, (4) VCG angle between P and QRS loop axes >30°, (5) abnormal fQRSd duration, (6) abnormal LVPs (3/3 or 2/3, (7) highly abnormal LAPs (abnormal nPd+abnormal fPd).