Zależność między entropią aproksymacji rytmu serca a strukturalną i funkcjonalną przebudową przedsionków oraz przebiegiem klinicznym napadowego i przetrwałego migotania przedsionków

Abstract

Introduction. Atrial remodeling due to atrial fibrillation (AF) is characterized by electrical and structural changes of cardiomyocytes that are in response for arrhythmia self-perpetuation and resistance to sinus rhythm conversion. This project was designed to study nonlinear methods of heart rate variability (HRV) (such as approximate entropy of heart rate [ApEn]) that can best characterize LA structural and functional remodeling and its association with clinical course in patients with paroxysmal and persistent AF. Material and methods. Traditional time and frequency domain HRV indices were analyzed in 75 patients (mean age 55 [49–62] years, 79% male) with paroxysmal or persistent AF on a background of ischemic heart disease (IHD) and/or hypertension without significant structural myocardial damage and in 19 control patients without AF (mean age 56 [49–61] years, 63% male). Echocardiography was performed to assess size and function of left atrium (LA). Results. In patients with paroxysmal or persistent AF the ApEn value was significantly lower than in the control patients group. Echo-parameters of LA, characterizing its structure and function, were correlated with ApEn value. The AF duration was negatively correlated with the ApEn value. Its values less than 0.93 was associated with a larger LA size (> 39 mm) and more frequent AF. Conclusions. There is a strong correlation of ApEn value and atrial remodeling. ApEn values less than 0.93 are related to AF recurrence and can be considered as prognostic risk factor of structural and functional remodeling of the heart muscle in patients with AF.