Evaluation of atrial electromechanical delay in patients with micro-atrial fibrillation.

Background: Atrial fibrillation (AF) is a rhythm disorder characterized by very rapid and disorganized atrial-derived electrical activations with non-coordinated atrial contractions. Very short periods of AF-like activity (micro-AF) may be precursors to undetected silent episodes of atrial fibrillation. In our study, we examined the relationship between natriuretic peptide levels and echocardiography findings in patients with micro-atrial fibrillation. Materials and Methods: Patients who applied to the cardiology outpatient clinic with the complaint of palpitation and were fitted with a 24-hour rhythm Holter at the end of the examination, were included. Micro-AF is defined as the sudden beginning of irregular tachycardia with 5 consecutive supraventricular episodes and the absolute absence of pulses and p-waves lasting less than 30 seconds. Forty five patients in the micro-AF group and 45 patients in the control group were included in the study. Laboratory parameters, electrocardiographic (ECG), and echocardiographic findings of the two groups were compared. Results: Pro-BNP (Pro brain-type natriuretic peptide) and Serum Troponin T levels were higher in the micro-AF group, (13.09±11.45 vs. 4.41±2.46, p<0.001; 375.57±636.68 vs. 63.19±56.82, p<0.001, respectively.) Each 1 pg/dl increase in serum pro-BNP level increased the risk of micro-AF by 1.8%. In the ROC analysis, the cut-off value for Pro-BNP for the diagnosis of micro-AF was 63.4 pg/dl, with a sensitivity of 91.1% and a specificity of 73.3%. Atrial electro-mechanical delay durations were significantly higher in the micro-AF group. Inter-annulus plane electromechanical delay time (inter-annulus plane AEMD) to predict micro-AF was determined as a cut-off value of 18.5 seconds with a sensitivity of 93.3% and a specificity of 91.1%; Left intra-annulus plane electro-mechanical delay time(intra-annulus AEMD as a cut-off value of 11.5 seconds with a 95.6% sensitivity and 75.6% specificity was determined to predict micro-AF. In ECG evaluation, maximum P wave duration (P-max) (113.00±10.25 vs. 98.00±10.47; p<0.001), minimum P wave duration (P-min) (73.89±5.53 vs.70.00±6.39; p<0.001) and P wave dispersion (PWD) (39.11±7.93 vs.28.00±7.64; p<0.001) were longer in the micro-AF group. Conclusions: We may predict micro-AF patients by evaluating ECG and echocardiographic data and serum natriuretic peptide levels.