title: Prediction of the recurrence of atrial fibrillation after successful cardioversion with P wave signal-averaged ECG.
abstract: BACKGROUND
  The recurrence of atrial fibrillation (AF) was often observed after cardioversion.
  
  
  METHODS
  In our study, a P wave triggered P wave signal-averaged ECG (P-SAECG) was performed on 118 consecutive patients 1 day after successful electrical cardioversion in order to evaluate the utility of this method to predict AF after cardioversion. We measured the filtered P wave duration (FPD) and the root mean square voltage of the last 20 ms of the P wave (RMS 20).
  
  
  RESULTS
  During a 1-year follow-up, a recurrence was observed in 57 patients (48%). Patients with recurrence of AF had a larger left atrial size (41.9 +/- 4.0 vs 39.3 +/- 3.1 mm, P < 0.0003), a longer FPD (139.6 +/- 16.0 vs 118.2 +/- 14.1 ms, P < 0.0001), and a lower RMS 20 (2.57 +/- 0.77 vs 3.90 +/- 0.99 microV, P < 0.0001). A cutoff point (COP) of FPD > or =126 ms and RMS 20 < or =3.1 microV could predict AF with a specificity of 77%, a sensitivity of 72%, a positive value of 75%, a negative predictive value of 75%, and an accuracy of 75%. A stepwise logistic regression analysis of variables identified COP (odds ratio 9.97; 95% CI, 4.10-24.24, P < 0.0001) as an independent predictor for recurrence.
  
  
  CONCLUSIONS
  We conclude that the probability of recurrence of AF after cardioversion could be predicted by P-SAECG. This method seems to be appropriate to demonstrate a delayed atrial conduction that might be a possible risk factor of reinitiation of AF.
authors.affiliation: Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Hufelandstrasse 55, D-45122 Essen, Germany. marco.budeus@medizin.uni-essen.de
authors.forename: Marco
authors.initials: M
authors.lastname: Budeus
authors.forename: Marcus
authors.initials: M
authors.lastname: Hennersdorf
authors.forename: Christian
authors.initials: C
authors.lastname: Perings
authors.forename: Heinrich
authors.initials: H
authors.lastname: Wieneke
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000517:prevention & control*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004554:Electric Countershock / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention; D016896:Treatment Outcome