A P wave signal-averaged ECG threshold of FPD ≥125 ms and RMS 20 ≤3.3 µV independently predicted new-onset atrial fibrillation in heart failure patients (OR 18.71; 95% CI 4.85-72.16; P<0.0001).
Cohort (n=94)
Do P wave signal-averaged ECG parameters and chemoreflexsensitivity predict new-onset atrial fibrillation in patients with heart failure and LVEF <40%?
P wave signal-averaged ECG parameters (FPD and RMS 20) can independently predict the risk of new-onset atrial fibrillation in patients with heart failure and reduced ejection fraction.
Effect estimate: OR 18.71 (95% CI 4.85-72.16)
p-value: p=< 0.0001
AIMS: Atrial fibrillation (AF) is a common arrhythmia in advanced heart failure. The occurrence of AF increases the risk of death and hospitalization for patients with heart failure. The results of different studies indicated that patients with paroxysmal AF have a longer filtered P wave duration (FPD), a lower root mean square voltage of the last 20 ms of the P wave (RMS 20), and a lower chemoreflexsensitivity (CHRS). Our study bases on these observations in order to examine the methods for predicting AF in patients with a left ventricular ejection fraction below 40% without a prior documentation of AF. METHODS AND RESULTS: The ratio between the difference of RR intervals in ECG and venous pO(2) before and after 5-min oxygen inhalation was measured (ms/mmHg) in order to determine the CHRS. A P wave signal-averaged ECG was performed for the measurement of FPD and RMS 20. The measurements were only performed in 94 patients with sinus rhythm. AF occurred during the mean follow-up of 39.9 months in 24 patients (26%). There were no significant differences concerning age, heart diseases, sex, ejection fraction, heart rate, or the use of drugs. The FPD (130.3 +/- 4.2 vs. 118.9 +/- 12.4 ms, P or=125 ms and RMS 20 or=125 ms and RMS 20 <or=3.3 microV (OR 18.71; 95% CI, 4.85-72.16, P < 0.0001) as independent predictors for AF. CONCLUSIONS: In summary, our data show that the results of a P wave signal-averaged ECG can predict the risk for new onset of AF in patients with heart failure. The value of signal-averaged FPD is probably the result of reflecting the intra-atrial conduction delay, which is a pathophysiological condition for AF. The CHRS is not a suitable method for predicting AF.
Budeus et al. (Tue,) conducted a cohort in Heart failure with left ventricular ejection fraction <40% (n=94). P wave signal-averaged ECG (FPD and RMS 20) was evaluated on New onset of atrial fibrillation (OR 18.71, 95% CI 4.85-72.16, p=< 0.0001). A P wave signal-averaged ECG threshold of FPD ≥125 ms and RMS 20 ≤3.3 µV independently predicted new-onset atrial fibrillation in heart failure patients (OR 18.71; 95% CI 4.85-72.16; P<0.0001).
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