Yoon et al identified findings on echocardiography that are associated with progression of paroxymal atrial fibrillation to persistent or permanent disease. These can help to identify a patient who may benefit from more aggressive management. The authors are from Seoul National University, Hallym University and Korean University in Seoul.
Patient selection: paroxysmal atrial fibrillation
Outcome: persistent or permanent atrial fibrillation
Parameters:
(1) left atrial strain (epsilon) during ventricular systole in percent (on speckle tracking echocardiography)
(2) maximal left atrial volume index in mL per square meter
(3) left atrial diameter in mm
(4) E velocity in cm/s
Parameter
Finding
Points
left atrial strain
<= 30.9 percent
1
> 30.9 percent
0
maximal LA volume index
<= 34.2 mL per sq m
0
> 34.2 mL per sq m
1
left atrial diameter
<= 39 mm
0
> 39 mm
1
E velocity
<= 62 cm/s
0
> 62 cm/s
1
total number of risk factors =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 4
• The risk for progression increases with the number of risk factors.
• LA strain was the strongest independent predictor.
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