Objective: The purpose of this study was to determine prospectively whether interatrial dyssynchrony detected by tissue Doppler imaging (TDI) is useful for predicting the progression to chronic atrial fibrillation (CAF) in patients with nonvalvular paroxysmal AF (PAF).
Methods: Thirty-seven patients with nonvalvular PAF were prospectively followed after echocardiography. We measured the interval of time from initiation of the P wave on the electrocardiogram (ECG) until the beginning of the late diastolic TDI signal at the lateral border of the mitral annulus (P-A'(M)) and the tricuspid annulus (P-A'(T)). Interatrial dyssynchrony was defined as the difference between the P-A'(M) and P-A'(T) intervals (A'(M)-A'(T)). The study endpoint was the onset of CAF (>6 months).
Results: During a follow-up period of 28±23 months, 8 patients developed CAF. Compared to those without CAF, the patients who developed CAF had a significantly lower atrial systolic mitral (A'(M)) (7.7±1.7 vs. 10.7±2.9 cm/sec, p<0.01) and tricuspid (A'(T)) (12.9±3.5 vs. 16.6±5.1 cm/sec, p<0.05) annular tissue Doppler velocity, as well as a longer A'(M)-A'(T) interval (47±13 vs. 24±10 msec, p<0.0001). Kaplan-Meier analysis, using cutoff values determined by analysis of receiver-operating characteristics curves, revealed that progression to CAF was significantly more frequent when A'(M)-A'(T) interval was ≥34 msec (p<0.01), A'(M) velocity was ≤9 cm/sec (p<0.05), and A'(T) velocity was ≤16 cm/sec (p<0.05).
Conclusions: This prospective study suggests that nonvalvular PAF patients with a high risk of developing CAF have "interatrial dyssynchrony" and "atrial systolic dysfunction" on atrial TDI.
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