Instrumental markers of frequent symptomatic atrial fibrillation in patients with arterial hypertension
Authors: Danilevych TD , Ivanov VP 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Great attention of researchers is focused on the study of the features of electrical and structural remodeling of the heart in patients with atrial fibrillation (AF) and arterial hypertension (AH). Holter monitoring of the electrocardiogram (HM ECG) and echocardiography are used as methods for evaluating these changes.

Objectives
to determine instrumental markers of frequent symptomatic AF in patients with AH.

Methods
146 patients with AH stage II with AF (males 68 (46.6%)) and 26 patients with AH stage II (males 11 (42.3%)) were examined in Vinnitsa regional center of cardiovascular pathology. Mean age of patients with AH and AF was (61.2 ± 0.7) years and in group with AH (59.3 ± 2.2) years. The duration of AF was (5,7 ± 0,5) years. The frequency of AF attacks was (23,6 ± 1,2) days. Paroxysmal AF was in 56 (38.4%) patients and persistent AF was in 90 (61.6%) patients. 31 (21.2%) patients have vagal, 70 (47.9%) patients have adrenal and 45 (30.9%) patients have mixed variant of AF (by Coumel). All patients underwent HM ECG and transthoracic echocardiography according to the standard protocol.

Results
ECG markers of frequent symptomatic AF are: amount of frequent supraventricular premature beats (SPB) (2198 vs 24, p &lt; 0,0001), including paired and group SPBs (83,3% vs 0, p &lt; 0,0001), presence of short asymptomatic episodes supraventricular paroxysmal tachycardia (SVPT)(33,3% vs 0, p &lt; 0,0001) or AF (41,1% vs 0, p &lt; 0,0001), increasing dispersion of QT interval (90 vs 70, p = 0,03) and decreasing dispersion ratio PQ/QT (0,50 vs 0,73, p = 0,03). Using the method of multiple linear regression, we determined the most informative combination of these markers: presence of SPBs more than 330 episodes/day + presence of pair and group SPBs and + presence of asymptomatic episodes of SVPT/AF (R = 0,52, p = 0,00002). Hemodynamic markers of frequent symptomatic AF are: significant increasing of absolute and relative indices of size/volume of left atrium (LA) (p &lt; 0,0001), increasing of LA/right atrium (1,12 vs 0,92, p &lt; 0,0001) and LA volume (LAV)/left ventricular myocardial mass (LVMM) (0,27 vs 0,21, p &lt; 0,0001), decreasing Ve/Va (0,82, vs 0,92, p = 0,01) and isovolumic relaxation time (IVRT)(88 vs 97, p = 0,01); mitral (72,2% vs 46,2%, p = 0,01) and tricuspid (48% vs 23,1%, p = 0,02) regurgitation. Using the method of multiple linear regression, the most informative combination of these markers is: the ratio of LAV/LVMM &gt; 0.23 ml/g + LA&gt; 40 mm + presence of mitral regurgitation (R = 0,49, p = 0,00009).

Conclusions
As the most informative ECG markers of frequent symptomatic AF in patients with AH is combination of frequent SPBs (&gt; 330 episodes/day) with pair and group SPBs and asymptomatic episodes SVPT/AF (R = 0,52, p = 0.00002 ), while echocardiography combination of markers is ratio of LAV/LVMM &gt; 0.23 ml/g + LA&gt; 40 mm + presence of mitral regurgitation (R = 0.49, p = 0.00009).