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Prediction of paroxysmal atrial fibrillation in patients with congestive heart failure: a prospective study

Takahisa Yamada, MD^*, Masatake Fukunami, MD^* , Tsuyoshi Shimonagata, MD^*, Kazuaki Kumagai, MD^* , Hisakazu Ogita, MD^* , Yoshihiro Asano, MD^* , Akio Hirata, MD^* , Masatsugu Hori, MD^* and Noritake Hoki, MD^*

^* Division of Cardiology, Osaka Prefectural General Hospital, Osaka, Japan
First Department of Internal Medicine, Osaka University Medical School, Osaka, Japan

View larger version (32K): [in a new window]   Figure 1 Representative tracings of P-SAE (P-SAECG) in a patient who developed PAF (left, group I) and a patient who did not develop PAF (right, group II) during the follow-up period. Note that the signal-averaged P-wave duration is longer and the terminal portion of the signal-averaged P wave is lower in the group I patients than in the group II patients. The abnormality of the P-SAECG was Ad >132 ms and LP20 <2.3 µV (positive in group I; negative in group II).

View larger version (18K): [in a new window]   Figure 2 PAF-free rate curves according to Kaplan-Meier analysis in patients with and without an abnormal P-SAE (P-SAECG) (Ad >132 ms and LP20 <2.3 µV). The bold line (29 patients with the abnormality) and the narrow line (46 patients without the abnormality) show the PAF-free rates. The numbers at the bottom are the number of patients in each group at risk for the event (PAF attack) at study entry and after each 100-day period. The PAF-free rate was significantly lower in patients with rather than without an abnormal P-SAECG.

View larger version (24K): [in a new window]   Figure 3 Plots of Ad and LP20 in patients with and without the development of PAF. The Ad was significantly longer and the LP20 was smaller in patients with rather than without the development of PAF.

View larger version (29K): [in a new window]   Figure 4 Plots of neurohumoral pattern in patients with and without the development of PAF. The ANP concentration was significantly higher in patients with rather than without the development of PAF, although there were no differences in the plasma level of norepinephrine, aldosterone or renin between the groups.

View larger version (19K): [in a new window]   Figure 5 The PAF-free rate curves according to Kaplan-Meier analysis in patients with and without an elevated ANP level. The bold line (25 patients with an elevated ANP level 60 pg/ml) and the narrow line (50 patients without an elevated ANP level) show the PAF-free rate. The numbers at the bottom are the number of patients in each group at risk for the event (PAF attack) at study entry and after each 100-day period. The PAF-free rate was significantly lower in patients with rather than without an elevated ANP level.