title: A combination of P wave electrocardiography and plasma brain natriuretic peptide level for predicting the progression to persistent atrial fibrillation: comparisons of sympathetic activity and left atrial size.
abstract: OBJECTIVE
  Development of atrial fibrillation (AF) is complexly associated with electrical and structural remodeling and other factors every stage of AF development. We hypothesized that P wave electrocardiography with an elevated brain natriuretic peptide (BNP) level would be associated with the progression to persistence from paroxysmal AF.
  
  
  METHODS
  P wave electrocardiography such as a maximum P wave duration (MPWD) and dispersion by 12-leads ECG, heart/mediastinum (H/M) ratio by delayed iodine-123 metaiodobenzylguanidine scintigraphic imaging, left ventricular ejection fraction (LVEF), and left atrial dimension (LAD) by echocardiography, and plasma BNP level were measured to evaluate the electrical and structural properties and sympathetic activity in 71 patients (mean ± standard deviation, age: 67 ± 13 years, 63.4 % males) with idiopathic paroxysmal AF.
  
  
  RESULTS
  Over a 12.9-year follow-up period, AF developed into persistent AF in 30 patients. A wider MPWD (>129 ms) (p = 0.001), wider P wave dispersion (>60 ms) (p = 0.001), LAD enlargement (>40 mm) (p = 0.001), higher BNP level (>72 pg/mL) (p = 0.002), lower H/M ratio (≤2.7) (p = 0.025), and lower LVEF (≤60 %) (p = 0.035) were associated with the progression to persistent AF, and the wide MPWD was an independently powerful predictor of the progression to persistent AF with a hazard ratio (HR) of 5.49 [95 % confidence interval (CI) 2.38-12.7, p < 0.0001] after adjusting for potential confounding variables, such as age and sex. The combination of wide MPWD and elevated BNP level was additive and incremental prognostic power with 13.3 [2.16-13, p < 0.0001].
  
  
  CONCLUSIONS
  The wide MPWD with elevated BNP level was associated with the progression to persistent AF.
authors.affiliation: Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan, hzn01233@s02.itscom.net.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Akutsu
authors.forename: Kyouichi
authors.initials: K
authors.lastname: Kaneko
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kodama
authors.forename: Fumito
authors.initials: F
authors.lastname: Miyoshi
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Li
authors.forename: Norikazu
authors.initials: N
authors.lastname: Watanabe
authors.forename: Taku
authors.initials: T
authors.lastname: Asano
authors.forename: Kaoru
authors.initials: K
authors.lastname: Tanno
authors.forename: Jumpei
authors.initials: J
authors.lastname: Suyama
authors.forename: Atsuo
authors.initials: A
authors.lastname: Namiki
authors.forename: Takehiko
authors.initials: T
authors.lastname: Gokan
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D018450:Disease Progression; D018572:Disease-Free Survival; D004452:Echocardiography / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009929:Organ Size; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013318:Stroke Volume
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
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