Predictors of Clinical Recurrence after Successful Electrical Cardioversion of Chronic Persistent Atrial Fibrillation: Clinical and Electrophysiological Observations

Abstract

Recurrence of atrial fibrillation (AF) after electrical cardioversion of chronic AF is not uncommon. However, it remains unclear which parameter(s) predict clinical recurrence. To assess the potential predictors of clinical recurrence after successful electrical cardioversion, we analyzed clinical, echocardiographic and electrophysiologic parameters in 36 patients (age 63 ± 11 years; 26 males, 10 females) with chronic persistent AF lasting more than 3 months. The dimensions of the left atrium and left ventricular end diastole and end systole were measured by echocardiography. The P wave characteristics from the surface 12-lead electrocardiogram (ECG) were studied in sinus rhythm. Atrial local activations were studied by biatrial basket electrode mapping in AF. With a mean of 7 ± 2 months of follow-up, 17 (47%) patients had AF recurrence despite multiple antiarrhythmic drug therapy. None of the clinical or echocardiographic parameters were relevant to the recurrence. However, among the surface ECG and intraatrial electrophysiological parameters, the mean P wave duration was the only independent predictor of the risk of clinical recurrence after successful electrical cardioversion. The sensitivity and predictive accuracy of recurrence were 82 and 70%, respectively, when the mean P wave duration was more than 125 ms.

Duration of P‐Wave Is Associated with Atrial Fibrillation Hospitalizations in Patients with Atrial Fibrillation and Paced for Bradycardia

“…We found a correlation between P‐wave duration and AF‐related hospitalizations and incidence of cardioversions. This finding corroborates the correlation between P‐wave duration and AF recurrences found in previous studies 7–17 . Yet, we did not find a significant correlation between P‐wave duration and AF recurrences.…”

“…This finding corroborates the correlation between P-wave duration and AF recurrences found in previous studies. [7][8][9][10][11][12][13][14][15][16][17] Yet, we did not find a significant correlation between P-wave duration and AF recurrences. This difference between our study and previous ones 7,17 may be explained by the fact that in our study we counted all AF episodes (device-defined) symptomatic or not, in contrast to the methodology in previous studies where AF recurrences were recorded by symptoms or via ECG recordings during regular visits, thereby measuring only symptomatic and/or persistent AF episodes.…”

“…A P-wave >120 ms and P-wave morphologynotched or biphasic-have been considered expressions of interatrial or intraatrial conduction disturbances and associated with a higher risk of AF occurrence in various patient populations, [7][8][9][10][11][12]16,17 such as lone AF or those with structural heart disease treated by coronary artery surgery. In patients with a conventional indication for a VVI pacemaker, Snoeck et al 13 found a significant correlation between the P-wave duration at implantation and the incidence of paroxysmal AF at follow-up.…”

“…The association of AF with intra-and interatrial conduction disturbances, manifested on the surface electrocardiogram (ECG) by a prolonged P-wave, was described many years ago. 7,8 Since then, many studies in a variety of patient populations [9][10][11][12][13][14][15][16][17] have addressed the association of AF with P-wave duration, morphology, or dispersion. However, no study has investigated the role of Pwave duration on the long-term prognosis of AF patients.…”

The role of HATCH score in predicting the success rate of sinus rhythm following electrical cardioversion of atrial fibrillation

“…In previous studies, it has been stated that clinical parameters such as antiarrhythmic medication, valvular disease, statin, beta-blocker, and angiotensin converting enzyme/angiotensin receptor blocker (ACE/ARB) use before cardioversion, LA dilatation, pulmonary disease, cardiomyopathy, HT, body weight, duration of AF, and OSAS can be indicative for the success of cardioversion [7][8][9][10][11][12][13][14][15][16][17][18]. However, in this study only COPD, CHF, OSAS, valvular disease, HATCH score, LA diameter, EF, and age remained as independent predictors of unsuccessful EC.…”