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|Title:||Characteristics of ectopic triggers associated with paroxysmal and persistent atrial fibrillation: evidence for a changing role|
|Citation:||Heart Rhythm, 2012; 9(9):1367-1374|
|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.|
Atrial Premature Complexes
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|Rights:||Crown Copyright © 2012 Published by Elsevier Inc. on behalf of Heart Rhythm Society. All rights reserved.|
|Appears in Collections:||Aurora harvest 5|
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