Some Risk Factors Of Atrial Fibrillation In Patient With Primary Hypertension With Paroxysmal Atrial Fibrillation

Objective: Atrial fibrillation is one of the most prevalentarrthythmias. Recent technological advances majored in preventionatriaI fibrillation and its comPlication. Risk assessmellt in patientswith atrial fibrillation is imPortan for early diagnosisand treatment. There are two atfial fibrillation Predictors:electrophysiologic factors (p wave dufation, late atrialpotential,monophasic action potential), and cardio stmctllra1 andfunctional factorS (atrial and ventricular structure etc). however,articles which integrate electrophysiologic factors with structuralfactors is little. We analyze the prevalence of risk factors in patientswith primary hyPertension paroxysmal atYial fibrillaton bymeans of electrophysiologic examination (such aselectrocardiograPhy, ambulatory electrocardiograPhy heart ratevariability) and doppler echocardiograPhic.Methods: Thirty patients with primary hypertension withparoXysmal atrial flbrillation (PAF grouP) and twenty five patientswith primary hypertension but without atrial fibrillation (controlgroup) entered study ElectrocardiograPhy, ambulatoryelectrocardiograPhy heart rate variability were performed.DopplerechocardiograPhic were conducted. P wave dispersion, P waveduration (maxium), frequency of atrial prematllre beats and running,(standard deviation of all normal to normal ax ifltervals(SDNN).mean of the standard deviation of all NNintervals for all 5-min segments(288) of 24 hour(SDNNindex) left atrial diameter(LAD), left atrial diameter toaortic root diameter ration (LA/AO), thickness of inter ventricularseptal (IVSd) and thicAness of interventricular septal to leftventricular posterior wal1 ratio (IVS/LVPW), left ventriculardiastolic diameter(LVIDd), trans-mitral valve atrial systolicwave(A), trans mitral valve diastolic wave(E), left atrial aPpendageempty velocity(LAA-E), left atrial aPpendage fillingvelocity(LAA-F), trans left upper pulmonary venous systolicwave(LUPVS),trans left uPper pulmonary venous diastolicwave(LUPVS). Left uPper pulmonary venous atrial systolicwave(LUPVA), interatrial septal motion(IASd).Results: The Pmax .Pd (0.0995l0.027s and 0.058l0.022s) inPAF group during sinus rhythm was significantly greater than thatin control grouP (0.076l0.0l7s and 0.039l0.013) P<0.01.TheSDNN valve amounted to l26.67l39.36 and 104.43l28.1l(P<0.05)for PAF grouP and control grouP. The SDNNIndex Valve amountedto 5l .07ll l .56 and 40.57l9.33,P<0.01) for PAF group and controlgroup. The frequency of atrial premature beat and atrialtachycardia in PAF grouP was greater than that in control group.The LUPVA flow wave significanly higher in the PAF grouP thanin the colltfol group. About LUPVS, most of patients in colltrolgroup show biphasic systolic forward flow pattern, but less in PAFgroup, P<0.05,There were no significant difference in age .weight,LAD. LAD/AOD. IVSd. IVSd/LVPW LVIDd. E. A. E/A.LAA-E' LAA-F. LUPVS. LUPVD. IASd between tWo grouP.Pmax corre1ated positively with the SDNN (r=0.322, P<0.05) andcorrelated positively with the SDNNIndex (r=0.337, P<0.05).Discussion: Abnormalities of electrophysiology and structureand function in atrium ("electrophysiologic and mechanicalremodeling") may be the pOtential risks of atfial fibrillation. First,"electrophysiologic remodeling" include increasing dispersion ofatrial inPulse conduction and shortening of the action potentialduration. While atfial premature beat promote the attacking ofatrial fibrillation. Second, about "mechanical remodeling". Therewere no significant difference in cardiac stfuctllre between tWogrouPs. And this may be one of the reason that PAF restore to sinusrhythm spontaneously In primary hyPertension patient withPAF 9 no obvious "stulling" could be found in left atrialaPpendage and left atfium. But echocardiograPhic show decreasingof the comPliance of the atrium in primary hyPertension patientwith PAF grouP. Enhanced auonomic...