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
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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: 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.To determine the APC characteristics in terms of burden and relative coupling interval with progression of the AF disease process.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).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])."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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