Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/73712
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Type: Journal article
Title: Characteristics of ectopic triggers associated with paroxysmal and persistent atrial fibrillation: evidence for a changing role
Author: Brooks, A.
Rangnekar, G.
Ganesan, A.
Salna, I.
Middeldorp, M.
Kuklik, P.
Baumert, M.
Roberts-Thomson, K.
Sanders, P.
Citation: Heart Rhythm, 2012; 9(9):1367-1374
Publisher: Elsevier Inc.
Issue Date: 2012
ISSN: 1547-5271
1556-3871
Statement of
Responsibility: 
Anthony G. Brooks, Geetanjali Rangnekar, Anand N. Ganesan, Ingrid Salna, Melissa E. Middeldorp, Pawel Kuklik, Mathias Baumert, Kurt C. Roberts-Thomson and Prashanthan Sanders
Abstract: <h4>Background</h4>Atrial premature contractions (APCs) are well described to precede the initiation of paroxysmal atrial fibrillation (pAF). However, whether APC characteristics alter with progression of the arrhythmia is unknown.<h4>Objective</h4>To determine the APC characteristics in terms of burden and relative coupling interval with progression of the AF disease process.<h4>Methods</h4>Fifty consecutive patients with pAF, 50 consecutive patients with persistent AF (perAF), and 25 age-matched controls underwent clinical review, transthoracic echocardiography, and ambulatory electrocardiogram monitoring. After excluding 29 patients who had AF for the entire recording (n = 24) or unreliable recordings (n = 5), we analyzed data from 49 patients with pAF, 24 patients with perAF, and 23 healthy controls. All normal morphology R-R intervals with a >25% decrease in R-R coupling compared with the previous R-R interval (coupling interval index) were deemed APCs (n = 95,873).<h4>Results</h4>The median APC burden was higher in patients with pAF (2 [1-22] APCs/h; P = .004) and perAF (3 [1-6] APCs/h; P = .04) than in controls (1 [0-1] APCs/h) but was not different (P = .66) between the AF subgroups. Patients with pAF had a distinct increase in ectopy burden after 7 PM and elevation throughout the night (P = .002) in comparison with a blunted and complementary temporal response in the perAF cohort (P = .01). Patients with pAF demonstrated a greater proportion of shortly coupled APCs (29% [13-45]; P = .04) compared with persistent arrhythmia (17% [5-29]).<h4>Conclusions</h4>"Real-life" atrial trigger statistics of APC burden, timing, and diurnal rhythms track the transition from a trigger-based, autonomically sensitive paroxysmal arrhythmia to a more substrate-based persistent disease.
Keywords: Heart Atria; Humans; Atrial Fibrillation; Atrial Premature Complexes; Disease Progression; Electrocardiography, Ambulatory; Risk Factors; Case-Control Studies; Heart Rate; Time; Middle Aged; Female; Male; Statistics as Topic
Rights: Crown Copyright © 2012 Published by Elsevier Inc. on behalf of Heart Rhythm Society. All rights reserved.
RMID: 0020121784
DOI: 10.1016/j.hrthm.2012.03.062
Appears in Collections:Medicine publications

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