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. 2022 Apr 22;17(4):e0266848.
doi: 10.1371/journal.pone.0266848. eCollection 2022.

Signs of left atrial disease and 10-year risk of atrial fibrillation

Tobias Uhe  1 , Tina Stegmann  1 , Romy Langhammer  1 , Nikolaos Dagres  2 , Ulrich Laufs  1 , Rolf Wachter  1
Affiliations

Signs of left atrial disease and 10-year risk of atrial fibrillation

Tobias Uhe et al. PLoS One. .

Abstract

Background: The contribution of left atrial disease and excessive supraventricular ectopic activity (ESVEA) to the risk for incident atrial fibrillation (AF) is incompletely understood.

Objective: To analyse the ten-year risk to develop AF in patients with cardiovascular risk factors and to define the impact of parameters of left atrial disease and ESVEA on AF risk.

Methods: 148 patients from the Diast-CHF trial with at least one cardiovascular risk factor and free of AF at baseline were followed for 10 years. Left atrial disease was defined as left atrial volume index (LAVI) >35 ml/m2, P-terminal force in lead V1 (PTFV1) >4000 ms*μV or elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) >250 pg/ml. We analyzed the association of these parameters and ESVEA (either >720 premature atrial contractions (PAC) or one atrial run >20 beats per day) on AF-free survival.

Results: After ten years, AF was newly detected in twelve patients (13.4%) with signs of left atrial disease and two patients (3.4%) without signs of left atrial disease (p = 0.04). LAVI (p = 0.005), ESVEA (p = 0.016) and NT-proBNP (p = 0.010) were significantly associated with AF-free survival in univariate analysis. A combined Cox model of left atrial disease parameters showed associations for NT-proBNP (HR 3.56; 95%CI 1.33-5.31; p = 0.04) and PAC (HR 2.66; 95%CI 1.25-10.15; p = 0.01) but not for LAVI or PTFV1 with AF-free survival.

Conclusion: The risk for AF is higher in patients with cardiovascular risk factors and signs of left atrial disease. NT-proBNP and premature atrial contractions independently predict AF-free survival. The role of excessive supraventricular ectopic activity for the assessment of AF risk may be underestimated and requires further study.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study flow chart.
AF = Atrial fibrillation; SR = Sinus rhythm; Of 162 patients described in Seegers et al. [14], 4 patients had AF in medical history and 10 had AF in baseline Holter ECG. Of 148 patients with SR in Holter ECG, 110 patients completed 10y-follow-up, 18 patients died, and 20 patients were lost to follow-up for other reasons.
Fig 2
Fig 2. Venn diagram of distribution of left atrial disease parameters.
66 patients (45%) had abnormal PTFV1 (green circle), 38 patients (26%) had elevated plasma levels of NTproBNP (blue circle), and 22 patients (15%) had elevated left atrial volume index (red circle). LAVI = indexed left atrial volume; PTFV1 = P-terminal force in V1, NT-proBNP = N-terminal pro-B-type natriuretic peptide.
Fig 3
Fig 3. Kaplan-Meier curves of AF-free survival for the different parameters of left atrial disease.
(A) AF-free survival in patients with NT-proBNP ≤250 pg/ml and >250 pg/ml. (B) AF-free survival in patients with LAVI ≤35 ml/m2 and >35 ml/m2. (C) AF-free survival in patients with PTFV1> 4000μV*ms and PTFV1≤4000μV*ms. (D) AF-free survival in patients with ESVEA and no ESVEA. AF = Atrial fibrillation; LAVI = Left atrial volume index; ESVEA = Excessive supraventricular ectopic activity.
See this image and copyright information in PMC

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