title: Reverse electrical remodeling of the atria post cardioversion in patients who remain in sinus rhythm assessed by signal averaging of the P-wave.
abstract: OBJECTIVE
  This study was designed to determine whether the signal-averaged electrocardiogram of the P-wave (SAPW) is an independent predictor of recurrence of atrial fibrillation (AF) post cardioversion (CV), and to assess atrial remodeling using SAPW.
  
  
  BACKGROUND
  There are limited electrophysiologic data to predict the recurrence of AF post-CV. The electrical remodeling that occurs post-CV is poorly understood.
  
  
  METHODS
  Sixty-four patients with persistent AF undergoing CV were prospectively enrolled. SAPW parameters were measured the day of CV and repeated at 1 month. These SAPW parameters were compared to other baseline indices for the recurrence of AF.
  
  
  RESULTS
  Sixty patients (94%) had successful CV. At 1 month, 22 (37%) maintained sinus rhythm (SR). The SAPW total duration decreased significantly in those who remained in SR (159 ms +/- 19 to 146 ms +/- 17; P < 0.0001). Only the duration of AF (46 +/- 50 days vs 147 +/- 227 days, P = 0.03) and the presence of left ventricular hypertrophy (LVH, 12% vs 65%, P = 0.0006) were significantly associated with recurrence of AF. Atrial size strongly correlated with the SAPW duration in patients who remained in SR (R(2)= 0.67, P = 0.003) but not in those who returned to AF (R(2)= 0.11, P = 0.65).
  
  
  CONCLUSIONS
  Atrial electrical reverse remodeling occurs in patients with AF who maintain SR post-CV. This remodeling is likely inversely related to the duration of AF and LVH. SAPW duration does not predict recurrence of AF post-CV.
authors: Department of Electrophysiology, Mount Sinai Medical Center, New York, New York, USA. Nagib@med.umich.edu
authors: Nagib
authors: N
authors: Chalfoun
authors: David
authors: D
authors: Harnick
authors: Elena
authors: E
authors: Pe
authors: Manish
authors: M
authors: Undavia
authors: Davendra
authors: D
authors: Mehta
authors: J Anthony
authors: JA
authors: Gomes
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D016009:Chi-Square Distribution; D004452:Echocardiography; D004554:Electric Countershock; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted