Abstract 13598: Prediction of the Development of Atrial Fibrillation in Patients With Chronic Heart Failure by the Combination of Atrial Late Potential and Cardiac I-123 Metaiodobenzylguanidine Imaging
Background: The prediction of atrial fibrillation (AF) is clinically important for the management of patients with chronic heart failure (CHF). Atrial late potentials (ALP) is useful for the prediction of AF development in CHF patients. On the other hand, cardiac I-123 Metaiodobenzylguanidine (MIBG) imaging provides prognostic information in CHF patients. However, it remains unclear whether the combination of ALP and MIBG imaging could improve the prediction of AF development.
Methods: We prospectively studied 103 CHF outpatients not having AF (NYHA class: 2.0±0.6) with radionuclide LV ejection fraction < 40% (29±8%). At the entry, the filtered P wave duration (Ad) and the root mean square voltage for last 20 ms of the filtered P wave (LP20) was measured on P wave signal-averaged electrocardiogram, and ALP was defined as “Ad>132ms” and “LP20<2.3μV”. Furthermore, the cardiac MIBG imaging was also performed at the entry. The cardiac MIBG washout rate (WR) was calculated, and abnormal WR was defined as >27% (:the mean WR+2SD in normal subject).
Results: During a mean follow-up period of 7.3±3.3 years, 20 of 103 CHF patients had AF development. AF development was significantly frequently observed in patients with than without ALP (33% vs 12%, p=0.01), and patients with than without abnormal WR (32% vs 8%, p=0.009). At multivariate Cox analysis, ALP (p=0.001) and abnormal WR (p=0.02) were independently significantly associated with AF development. Kaplan-Meier analysis revealed that patients with both ALP and abnormal WR had the AF development significantly more frequently than those with either ALP or abmormal WR, or those without them (50% vs 24% vs 0%, p=0.0003). The hazard ratio of ALP and abnormal WR for AF development was 5.4 (95%CI 1.8–16.5), which was greater than that of ALP (3.2, 95%CI 1.3–7.7).
Conclusion: The combination of ALP and MIBG WR could improve the prediction of AF development in CHF patients.
- © 2010 by American Heart Association, Inc.