Echocardiographic and electrocardiographic predictors for atrial fibrillation recurrence following cardioversion.
BACKGROUND
Identification of suitable candidates for cardioversion currently is not based on individual electrical and mechanical atrial remodeling. Therefore, this study analyzed the meaning of atrial fibrillatory rate obtained from the surface ECG (as a measure of electrical remodeling) and left atrial size (as measure of mechanical remodeling) for prediction of early atrial fibrillation (AF) recurrence following cardioversion.


RESULTS
Forty-four consecutive patients (26 men and 18 women, mean age 62 +/- 11 years, no antiarrhythmic medication at baseline) with persistent AF were studied. Fibrillatory rate was obtained from high-gain, high-resolution surface ECG using digital signal processing (filtering, QRST subtraction, Fourier analysis) before electrical cardioversion. Univariate and multivariate regression analysis revealed larger systolic left atrial area (Beta = 0.176, P = 0.031) obtained by precardioversion echocardiogram from the apical four-chamber view and higher atrial fibrillatory rate (Beta = 0.029, P = 0.021) to be independent predictors for AF recurrence (n = 13). Stratification based on the regression equation (electromechanical index [EMI] = 0.176 systolic left atrial area + 0.029 fibrillatory rate - 17.674) allowed identification of groups at low, intermediate, or high risk. No patient with an EMI < -1.85 had early AF recurrence, as opposed to 78% with an EMI > -0.25. Intermediate results (40% recurrence rate) were obtained when the calculated EMI ranged between -1.85 and -0.25 (P < 0.001).


CONCLUSIONS
Fibrillatory rate obtained from the surface ECG and systolic left atrial area obtained by echocardiography may predict early AF recurrence in patients with persistent AF. These parameters might be useful in identifying candidates with a high likelihood of remaining in sinus rhythm after cardioversion.
Bollmann
Andreas
A
Department of Cardiology, University Hospital Magdeburg, Magdeburg, Germany. andreas.bollmann@medizin.uni-magdeburg.de
Husser
Daniela
D
Steinert
Reiko
R
Stridh
Martin
M
Soernmo
Leif
L
Olsson
S Bertil
SB
Polywka
Daniela
D
Molling
Jochen
J
Geller
Christoph
C
Klein
Helmut U
HU
D000368:Aged; D000465:Algorithms; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D055502:Secondary Prevention; D012850:Sinus of Valsalva / Q000503:physiopathology; D013318:Stroke Volume; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents