ELECTROCARDIOGRAPHIC AND TISSUE DOPPLER LEFT ATRIAL ABNORMALITIES IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION
Aim. The aim of this study is to analyze the electrocardiographic left atrial abnormalities (LAA) in relation with the Pulsed wave tissue Doppler imaging (PW-TDI) of the left atrium, as well the relation of LAA and PW-TDI to the CHA2DS2-VASc score and the role of these abnormalities in predicting the recurrence of the atrial fibrillation.
Methods. I studied two groups of patients, 15 without LAA and 15 with LAA, using anamnesis, surface electrocardiogram, two-dimensional and pulsed wave tissue Doppler echocardiography. The LAA were: prolonged P wave duration, prominent notching of P wave, ratio between the duration of the P wave and duration of the PR segment, increased duration and depth of terminal-negative portion of P wave. The left atrial wall velocities were recorded using PW-TDI as a triphasic signal formed by a positive A1 wave, followed by two negative A2 and A3 waves. The CHA2DS2-VASc risk scores were recorded and the patients were reevaluated in an interval between 3 and 6 months.
Results. From the 15 p. without ECG LAA, 3 had abnormalities at PW-TDI and in 12 p. with ECG LAA were also recorded PW-TDI abnormalities (p=0.0028). In 12 p. were not recorded any ECG and PW-TDI abnormalities, and 12 had both ECG and PW-TDI abnormalities. Only 8 patients with ECG and PW-TDI abnormalities had a CHA2DS2-VASc score 1 but only 1 patient without these abnormalities had a score greater than 0 (p=0.0094). At the reevaluation using anamnesis, surface ECG or Holter monitoring, only 1 patient without ECG and PW-TDI abnormalities had recurrent AF versus 7 from the group with both ECG and PW-TDI abnormalities.
Conclusions. It seems that there is a statistical significantly difference between the patients with ECG LAA regarding the left atria wall abnormalities, suggesting a high predictive accuracy of these ECG criteria in assessing atrial muscle abnormalities. Also, LAA in ECG and PW-TDI abnormalities together seem to have o high predictive value regarding both the thromboembolic risk and the risk for the recurrence of atrial fibrillation.