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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