RMS30 VOLTAGE FROM P-WAVE SAECG PREDICTS FUTURE RELAPSES IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION AND EARLY AFFECTED DIASTOLIC FUNCTION.
Purpose: Patients with a first documented episode of paroxysmal atrial fibrillation (PAF) may show future arrhythmia recurrences. To define markers for the prediction of future PAF episodes is of major clinical importance.
Methods: We prospectively enrolled 50 patients (mean age 65±15.4 years, 24 male) after the cardioversion of a documented PAF episode and #5 PAF episodes for the last 3 years. Screening was completed during the first 48 hours following cardioversion. Patients’ evaluation included 12 lead ECG, P-wave Signal- Averaged ECG, 30 min High Resolution Holter recording and a complete echocardiographic study [2D, conventional pulsed-Doppler (PWD) and tissue Doppler imaging (TDI)]. After 1 year of follow-up, patients were classified into those who showed PAF relapse (PAFR, n=10 pts) and those who remained in sinus rhythm (SR=40pts). A PAF relapse was verified by hospital readmission and ECG recording. All potential ECG and ECHO PAF predictors were calculated and analyzed for the two groups.
Results: The two groups did not differ in the autonomic nervous system status, left and right ventricular systolic function and left and right atrial volume indices. In contrast, diastolic function was found significantly affected for both left and right chambers (Table 20.1.).
After logistic regression analysis adjusted for RMS30, P dispersion, E/A LV and Em/Am LV, the RMS30 index remained an important and independent PAF predictor with Odds Ratio: 1.311 (p=0.024) 95%, CI: 1.035-1.660.
Conclusions: In the present cohort of patients with new documented PAF episodes, with the same autonomic nervous system status, same right and left ventricular systolic function but significantly affected diastolic properties, the RMS30 Voltage derived from P-wave SAECG was proven to be a significant and independent predictor of future PAF episodes.