Clinical, echocardiographic and Doppler correlates of clinical instability with onset of atrial fibrillation.
To identify clinical and Doppler echocardiographic correlates of instability with the onset of atrial fibrillation (AF), 87 consecutive patients with new-onset AF who had echocardiograms recorded during that hospital admission while in sinus rhythm were studied. Reviewers who were blinded to echocardiographic and Doppler data classified 51 patients (59%) as unstable because of the development of angina, congestive heart failure, syncope or hypotension with the onset of AF. Echocardiographic and Doppler data on transmitral blood flow velocity were analyzed by a single reviewer who was blinded to other clinical data. Multiple logistic regression analysis identified 3 variables as independent predictors of clinical instability with the onset of AF: (1) history of prior myocardial infarction (p less than 0.02); (2) echocardiographic evidence of left ventricular dysfunction (p less than 0.03); and (3) Doppler evidence of increased atrial filling fraction (p less than 0.0001). An atrial filling fraction threshold of 0.40 had a sensitivity for predicting clinical instability of 80% and a specificity of 72%. These data are consistent with the hypothesis that patients who are more dependent on the atrial contribution to ventricular filling are at increased risk of instability with AF due to the loss of atrial systole.
Tischler
M D
MD
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115.
Lee
T H
TH
McAndrew
K A
KA
Sax
P E
PE
Sutton
M S
MS
Lee
R T
RT
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology; D001783:Blood Flow Velocity / Q000502:physiology; D003326:Coronary Circulation / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012044:Regression Analysis