Clinical utility of dynamic chest radiography as an auxiliary tool for atrial fibrillation detection in heart failure: a pilot study

Background: Dynamic chest radiography (DCR) can estimate haemodynamic parameters in patients with heart failure (HF). Atrial fibrillation (AF) often coexists with HF; however, owing to its sometimes paroxysmal nature and minimal or absent symptoms, many patients with AF remain undiagnosed. Additional tools for AF diagnosis may be beneficial; therefore, we evaluated the ability of DCR to distinguish patients with HF in sinus rhythm (SR) from those with AF. Methods: In this small-sample pilot study, 20 patients with HF (median age, 67 years; males, 85%) underwent 12-lead electrocardiography and DCR on the same day. Aortic arch (Ao), right atrial (RA), right and left pulmonary artery (PA), and left ventricular (LV) apex pixel values (PVs) were measured. Seventeen patients were in SR and three demonstrated AF on 12-lead electrocardiography before DCR. Results: The PV and PV change rate waveforms of the Ao, RA, PAs, and LV apex were regular in SR and irregular with AF. The difference between patients in SR and those with AF was particularly clear in the LV apex PV change rate waveforms. In addition, the heart rates (HRs) of patients in SR and with AF could be calculated from the PV change rate waveforms and were similar to those calculated by 12-lead electrocardiography. Conclusions: DCR can detect AF in patients with HF and may be able to infer HR.