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Characteristics of ectopic triggers associated with paroxysmal and persistent atrial fibrillation: evidence for a changing role.

Abstract：

BACKGROUND:Atrial premature contractions (APCs) are well described to precede the initiation of paroxysmal atrial fibrillation (pAF). However, whether APC characteristics alter with progression of the arrhythmia is unknown. OBJECTIVE:To determine the APC characteristics in terms of burden and relative coupling interval with progression of the AF disease process. METHODS:Fifty consecutive patients with pAF, 50 consecutive patients with persistent AF (perAF), and 25 age-matched controls underwent clinical review, transthoracic echocardiography, and ambulatory electrocardiogram monitoring. After excluding 29 patients who had AF for the entire recording (n = 24) or unreliable recordings (n = 5), we analyzed data from 49 patients with pAF, 24 patients with perAF, and 23 healthy controls. All normal morphology R-R intervals with a >25% decrease in R-R coupling compared with the previous R-R interval (coupling interval index) were deemed APCs (n = 95,873). RESULTS:The median APC burden was higher in patients with pAF (2 [1-22] APCs/h; P = .004) and perAF (3 [1-6] APCs/h; P = .04) than in controls (1 [0-1] APCs/h) but was not different (P = .66) between the AF subgroups. Patients with pAF had a distinct increase in ectopy burden after 7 PM and elevation throughout the night (P = .002) in comparison with a blunted and complementary temporal response in the perAF cohort (P = .01). Patients with pAF demonstrated a greater proportion of shortly coupled APCs (29% [13-45]; P = .04) compared with persistent arrhythmia (17% [5-29]). CONCLUSIONS:"Real-life" atrial trigger statistics of APC burden, timing, and diurnal rhythms track the transition from a trigger-based, autonomically sensitive paroxysmal arrhythmia to a more substrate-based persistent disease.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Brooks AG,Rangnekar G,Ganesan AN,Salna I,Middeldorp ME,Kuklik P,Baumert M,Roberts-Thomson KC,Sanders P

doi

10.1016/j.hrthm.2012.03.062

subject

Has Abstract

pub_date

2012-09-01 00:00:00

pages

1367-74

issue

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(12)00352-9

journal_volume

pub_type

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Characteristics of ectopic triggers associated with paroxysmal and persistent atrial fibrillation: evidence for a changing role.