Risk Assessment of Asymptomatic Paroxymal Atrial Fibrillation by Using the P-Wave Signal-Averaged Electrocardiogram in Patients with Chronic Kidney Disease

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Background: Chronic kidney disease (CKD) has been reported to be an independent risk factor for new-onset atrial fibrillation (Af) and to increase the risk of thromboembolism in Af. Therefore, it is important to detect Af for CKD patients. The risk of paroxysmal Af can be detected while in sinus rhythm by P-wave signal-averaged electrocardiogram (P-SAE). In this study, we tried to assess the risk of paroxysmal Af by using the P-SAE in patients with and without CKD. Methods: In 272 patients who were admitted for coronary arteriography with no episode of previous Af, estimated glomerular filtration rate (eGFR) was calculated by the modified MDRD formula and the P-SAE was recorded to detect the presence of atrial late potential (LP). The relation between atrial LP and eGFR was analysed in the 2 groups, the control group (eGFR≥60 ml/min./1.73 m2) and the CKD group (eGFR<60 ml/min./1.73 m2). Results: In the CKD group (n=69), the atrial LP was observed in 29 patients (42%), and in 25 patients (12%) in the control group (n=203). The atrial LP was observed significantly more frequent in the CKD group (p<0.01). Conclusion: In patients who were suspected coronary artery disease, the risk of paroxysmal Af was significantly higher in the CKD group than in the control group. Recording the P-SAE may be an useful measure for detecting paroxysmal Af in CKD patients for stroke prevention.