title: Prediction of conversion from paroxysmal to permanent atrial fibrillation.
abstract: BACKGROUND
  Paroxysmal atrial fibrillation (PAF) transits to permanent atrial fibrillation (PEAF). The current study was to determine whether a P wave-triggered P wave signal averaged electrocardiogram (P-SAECG) and chemoreflexsensitivity (CHRS) are useful to predict a conversion to PEAF in patients with PAF.
  
  
  METHODS
  The filtered P wave duration (FPD) and the root mean square voltage of the last 20 ms of the P wave (RMS 20) were measured by P-SAECG. The ratio between the difference of RR intervals in the ECG and venous pO2 before and after 5-minutes oxygen inhalation is measured (ms/mmHg) for the determination of CHRS.
  
  
  RESULTS
  A total of 180 patients with PAF were enrolled and followed for a mean of 22.5 months. PEAF occurred in 38 patients (21%) and these patients had a significantly larger left atrial size (43.2 +/- 4.9 vs. 41.0 +/- 5.4 mm, P = 0.021), a significantly longer FPD (158.8 +/- 18.2 vs. 136.7 +/- 16.6 ms, P < 0.0001), and a significantly lower CHRS (1.96 +/- 0.99 vs. 2.44 +/- 1.19 ms/mmHg, P = 0.024) than patients with PAF. Patients with PEAF tended to have a lower RMS 20 (2.38 +/- 0.65 vs. 2.75 +/- 1.18 microV, P = 0.067) than patients with PAF. The chi(2) test showed that the combination of FPD > or = 145 ms, RMS 20 < or = 3.0 microV, left atrial size > or = 41 mm, and CHRS < or = 2.0 ms/mmHg had the best predictive power for PEAF. Patients who fulfilled these criteria had a 12-fold increased risk for a conversion from PAF to PEAF.
  
  
  CONCLUSIONS
  Our results show that a P-SAECG, an analysis of CHRS, and left atrial enlargement are clinical predictors of a progression from PAF to PEAF.
authors.affiliation: Department of Cardiology, West-German Heart Centre, University of Duisburg-Essen, Essen, Germany. marco.budeus@uk-essen.de
authors.forename: Marco
authors.initials: M
authors.lastname: Budeus
authors.forename: Oliver
authors.initials: O
authors.lastname: Felix
authors.forename: Marcus
authors.initials: M
authors.lastname: Hennersdorf
authors.forename: Heinrich
authors.initials: H
authors.lastname: Wieneke
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
mesh_terms: D000368:Aged; D000465:Algorithms; D001281:Atrial Fibrillation / Q000145:classification / Q000175:diagnosis*; D002628:Chemoreceptor Cells; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012018:Reflex; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity