Abstract 12657: "PAF Predicting Score" for Distinction of Paroxysmal and Non-paroxysmal Atrial Fibrillation by Using Clinical Parameters and Fibrillation Cycle Length in the Surface ECG
Background: In clinical practice, distinction of paroxysmal atrial fibrillation(PAF) and non-PAF is important because the primary treatment may be different, however, it is often difficult at the time of first documented AF episode. We have previously documented that the fibrillation cycle length (FCL) is longer in PAF cases than in non-PAF. The aim of this study was to compare various clinical parameters together with FCL to establish “PAF predicting score” to distinguish PAF and non-PAF cases.
Methods: The study population consisted of 203 consecutive patients who exhibited first documented AF in digital ECG recording in our institute between 2008 and 2011 (68 ± 12 years old, male: female = 144:59). They were divided into PAF and non-PAF groups (n = 62 and 141) by the following clinical course. For the FCL analysis, the fibrillation waves were purified by subtracting QRS-T template from the raw recording data and the spectral analysis was performed to obtain the peak power frequency. Clinical parameters and FCL were compared between the 2 groups. By utilizing significant independent predicting factors in the multivariate analysis, we constructed “PAF predicting score”.
Results: When comparing the 2 groups, gender (P = 0.0026), heart rate (HR, P ≤ 0.0001), left atrial diameter (LAD, P ≤ 0.0001), and FCL (P ≤ 0.0001) exhibited significant differences. In the multivariate analysis, HR, LAD, and FCL were independent predictors for PAF. For the scoring, cut-off value for each parameter were decided by ROC curve achieving highest sensitivity and specificity, i.e., HR > 81 bpm, LAD ≤ 42 mm, and FCL > 166 ms, and assigned 1 point for each parameter (3 points as maximum). In this scoring system, 3 points detected PAF with 84% sensitivity and 0 point predicted non-PAF with 100% sensitivity.
Conclusions: In patients with first documented AF, simple scoring using HR, LAD and FCL distinguished PAF and non-PAF patients with high sensitivity. This score may be useful in clinical practice to determine the initial therapy for first documented AF.
- © 2013 by American Heart Association, Inc.