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Atrial Tissue Doppler Imaging For Prediction Of New-Onset Atrial Fibrillation
  1. Cees B De Vos (cdvo{at}cardio.azm.nl)
  1. University Hospital Maastricht, Netherlands
    1. Bob Weijs
    1. University Hospital Maastricht, Netherlands
      1. Harry JGM Crijns
      1. University Hospital Maastricht, Netherlands
        1. Emile C Cheriex
        1. University Hospital Maastricht, Netherlands
          1. Andrea Palmans
          1. University Hospital Maastricht, Netherlands
            1. Jos Habets
            1. University Hospital Maastricht, Netherlands
              1. Martin H Prins
              1. University Hospital Maastricht, Netherlands
                1. Ron Pisters
                1. University Hospital Maastricht, Netherlands
                  1. Robby Nieuwlaat
                  1. University Hospital Maastricht, Netherlands
                    1. Robert G Tieleman
                    1. University Hospital Maastricht, Netherlands

                      Abstract

                      Objective: The total atrial conduction time (TACT) is an independent predictor of atrial fibrillation (AF). Recently, we developed a new transthoracic echocardiographic tool to determine the TACT by means of tissue Doppler imaging (PA-tdi). We hypothesized that measurement of PA-tdi enables prediction of new-onset atrial fibrillation.

                      Methods: We studied 249 patients without a history of AF. All patients underwent an echocardiogram and the PA-tdi interval was measured (the time from the initiation of the P-wave on the ECG (lead II) to the A’-wave on the lateral left atrial tissue Doppler tracing). Patient characteristics and rhythm at follow-up were recorded.

                      Results: During a mean follow-up of 680±290 days, fifteen patients (6%) developed new-onset AF. These patients had a longer PA-tdi interval compared to patients who remained in sinus rhythm (172±25ms versus 150±20ms, P=0.001). Furthermore, the patients developing AF were older, more often had a history of heart failure or chronic obstructive pulmonary disease, used more often alpha-blockers, had enlarged left atria and more frequently mitral incompetence on the echocardiogram. After adjusting for potential confounders, Cox regression showed that PA-tdi was independently associated with new-onset AF (OR: 1.375; 95%CI: 1.037-1.823; P=0.027). The 2-year incidence of AF was 33% in patients with a PA-tdi interval above 190 ms versus 0% in patients with a PA-tdi interval below 130 ms (p=0.002).

                      Conclusions: A prolonged PA-tdi interval may predict the development of new-onset AF. This parameter may be used to identify patients at risk in future strategies to prevent the development or complications of AF.

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