Incidence of atrial fibrillation paroxysms in chronic heart failure patients with preserved and reduced ejection fraction

Objective. To assess the risk of atrial fibrillation (AF) in patients with chronic heart failure (CHF) using a 24-hour Holter monitoring and distant ECG recording by portable single-channel device. Material and methods. The study involved 100 patients with CHF NYHA class I—IV with sinus rhythm. All patients underwent echocardiography with analysis of global strain of the left atrium and diastolic dysfunction. Along with a 24-hour Holter monitoring, additional three-day monitoring was performed. We also assessed distant ECG monitoring using telemedicine technologies (CardioQVARK device). The follow-up period was 1 month or until AF paroxysm. Results. Paroxysmal AF was detected in 20 (20%) patients. ECG in patients with complaints revealed 10% of AF paroxysms. Holter monitoring for 24, 48 and 72 hours revealed 5, 10 and 20% of AF paroxysms, respectively. When using the single-channel device CardioQVARK device 1, 2 and 3 times a day AF paroxysms were detected in 5, 55 and 15% of cases, respectively. This indicates a significant advantage of portable ECG recorder compared to other methods of sinus rhythm control in patients with CHF. There were significant changes of various indicators in patients with AF. Left atrial ejection fraction <36% was more common in patients with AF paroxysms (odds ratio (OR) 5.3, 95% CI 1.8—15.6, p=0.001). Global deformation of the left atrium <9.5% was more common in the same ones (OR 12.2, 95% CI 3.7—40.2, p=0.003). TDI E med <6.5 cm/s was more common in patients with AF (OR 10.2, 95% CI 2.2—47.6, p=0.001). Conclusion. Risk of AF in patients with CHF is high (up to 20%). Distant ECG monitoring methods are advisable in these ones for early detection of AF paroxysms and timely initiation of anticoagulant therapy. Echocardiography should be accompanied by assessment of global strain of the left atrium to determine the risk of AF.