Diagnostic accuracy of P-wave dispersion in prediction of maintenance of sinus rhythm after external cardioversion of atrial fibrillation

Abstract

ÖZETAmaç: P dalga dispersiyonu (PWD) atriyal iletimdeki farklılığı gösteren elektrokardiyografik bir ölçümdür. Bu çalışmanın amacı, eksternal kardiyoversiyon sonrası sinüs ritminde olan hastalarda PWD'nin atriyal fibrilasyon (AF) rekürrenslerini öngörmedeki tanısal değerini göstermektir. Yöntemler: Bu prospektif gözlemsel çalışmaya, başarılı eksternal kardiyoversiyonla sinüs ritmi sağlanmış, kapak hastalığı dışı persistan AF'si olan 26 hasta dâhil edildi (13 erkek, yaş ortalaması 58.1±11 yıl). Eksternal kardiyoversiyondan hemen sonra, P dalga süresini ölçmek için tüm hastaların 12 derivasyonlu yüzeysel elektrokardiyografileri çekildi. Sinüs ritmi sağlandıktan sonraki 12 aylık takip süresinde tüm hastaların tekrar eden AF'leri değerlendirildi. Hastalar AF rekürrens gelişimine göre 2 gruba ayrıldı (AF rekürrens grubu (n=19) ve sinüs ritim grubu (n=7)) ve bu gruplar, AF rekür-renslerini etkileyebilecek değişkenler açısından karşılaştırıldı. Atriyal fibrilasyon rekürrensinin bağımsız öngördürücülerinin belirlenmesinde basamaklı lojistik regresyon analizi ve bağımsız öngördürücülerin kestirim değerinin belirlenmesinde ROC eğrisi analizi kullanıldı. Bulgular: Her iki grubun demografik, klinik ve ekokardiyografik özellikleri benzerdi. Atriyal fibrilasyonu tekrarlayan hastaların PWD değerleri sinüs ritmi devam eden hastalara göre anlamlı olarak daha yüksekti (sırasıyla 80±21 msn ve 53±11 msn, p=0.001). P dalga dispersiyonundaki artış ile AF'nin tekrarlama riski arasında pozitif korelasyon izlendi (r=0.643; p<0.001).Lojistik regresyon analizinde PWD AF rekürrensinin bağımsız ABSTRACT Objective: P-wave dispersion (PWD) is an electrocardiographic measurement, which reflects a disparity in an atrial conduction. In this study, we aim to demonstrate the diagnostic accuracy of PWD in predicting recurrence of atrial fibrillation (AF) in patients with sinus rhythm restoration after external cardioversion. Methods: This prospective, observational study consists of 26 patients, who underwent external cardioversion for non-valvular persistent AF and successfully cardioverted to sinus rhythm (13 men, mean age 58.1±11 years). Twelve-lead surface electrocardiogram of each patient was recorded immediately after the external cardioversion process to measure the P-wave duration. Recurrent AF was assessed for each patient during the 12-month follow-up after restoring the sinus rhythm. Patients were divided into the 2 groups with respect to the AF recurrence (recurrent AF group, (n=19), and sinus rhythm group, (n=7)) and variables that can affect AF development were compared between the two groups.Stepwise logistic regression analysis was used to identify the independent predictors of AF recurrence and ROC curve analysis was performed to determine the cut-off value of independent factors. Results: The two groups have similar demographic, clinical and echocardiographic features. Patients with recurrent AF had significantly higher PWD than those who continued to have a sinus rhythm (80±21 msec vs 53±11 msec, p=0.001, respectively). There is ...

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