[The prediction of atrial fibrillation recurrence after electrical cardioversion with P wave signal averaged EKG].
METHODS
A P wave triggered and bidirectional P wave signal averaged ECG was used among 49 patients (35 m/14 w) 24 hours after electrical cardioversion. The measurements were only managed in sinus rhythm. Each patient was followed up for at least 6 months and the mean follow-up was of 9.1 months.


RESULTS
A recurrence of atrial fibrillation was observed in 23 patients (47%) after a mean of 9,2 days (range 2-92 days). There was no difference in organic heart disease or in the use of drugs. The filtered P wave duration (FPD) was longer significantly (136.2 +/- 20.1 vs 119.5 +/- 19.8 ms, p < 0.0001) and the root mean square voltage of the last 20 ms of the P wave (RMS 20) was lower (2.77 +/- 1.10 vs 4.17 +/- 1.43 microV, p < 0.0001) in patients with a recurrence of atrial fibrillation. A cut-off point (COP) of FPD > or = 126 ms and RMS 20 < or = 3.1 microV achieved a specificity of 69%, a sensitivity of 74%, a positive predictive value of 68% and a negative predictive value of 75%.


CONCLUSIONS
The results of our study suggest that the recurrence of atrial fibrillation after electrical cardioversion can be detected by P wave signal averaged ECG. The occurrence of COP seems to be a high risk factor of the recurrence of atrial fibrillation. The predictive power of the method has to be examined by prospective investigations of a larger patient population and a longer follow-up. The recurrence of atrial fibrillation after cardioversion has a high incidence. In our study, P wave signal averaged ECG was performed one day after successful electrical cardioversion in order to evaluate the utility of this method to predict atrial fibrillation after cardioversion.
Budeus
M
M
Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Klinik und Poliklinik B der Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany. budeus@med.uni-duesseldorf.de
Hennersdorf
M
M
Perings
C
C
Strauer
B E
BE
D000465:Algorithms; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000628:therapy*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity