WHAT IS THE MEANING OF FINDING A WANDERING ATRIAL RHYTHM?

Abstract

Objective: To know if the presence of a Wandering Atrial Rhythm (WAR), from childhood, is a pathophysiological condition that should be interpreted as an early sign of hypertension. Design and method: For this cross-sectional retrospective study, data were collected from 251 patients with episodes of WAR, registered during 24hs-Holter monitoring. Female-male (F-M) 126–125 mean age (SD) 56 (18.4) - 52 (18.3) from 6 to 89 years. Some patients were unaware of having hypertension, others with and without antihypertensive therapy. Was registered the anthropomorphic measures, systolic and diastolic blood pressure (S-DBP), heart rate, Central Haemodynamics Parameters, and difference of augmentation index (Diff-AIx) between observed values and normal levels, evaluated by applanation tonometry according to established protocols (SphygmoCor System-PVX AtCor-Medical Australia). Results: In the sample of males who were overweight from the 30 s, in females overweight/obese from the 40 s. In this study, the average of S-DBP before 20 years was registered in F-M 113.9/69–113.9/67.9 mmHg, and from 20 years to octogenarians in F-M was 140/82.5–136.8/84.2 mmHg. Among the groups of the F-M from 40–20 years, the average BP was higher than 120/80 mmHg. In all groups, the Central Haemodynamics Parameters (principally end-systolic pressure) and Diff-AIx (surrogate value of arterial stiffness) were higher than normal. A minimal mitral regurgitation was found in a female-male 38%-33.6% after 18–11 years, and brief phases of atrial fibrillation were found in 23%-19.2% from 35–48 years, respectively. Conclusions: Wandering Atrial Rhythm appearance is more early in life than minimal mitral regurgitation, it was observed during life even in octogenarians, which is correlated with an increase of S-DBP and Central Haemodynamics Parameters, and the frequent presence of atrial fibrillation. It could be interpreted as an early sign of hypertension from childhood.