Atrial premature complexes and heart rate have prognostic significance in 1-month atrial fibrillation recurrence after electrical cardioversion.
OBJECTIVE
The aim of this study was to investigate the significance of simple 24-h Holter (24H) data after electrical cardioversion (CV) for atrial fibrillation (AF) recurrence.


METHODS
We prospectively studied 47 consecutive patients subjected to CV, who successfully converted to sinus rhythm. All underwent echocardiography and 24H after CV. AF recurrence was studied at 14 days and 1 month by second 24H or by interim report of AF.


RESULTS
About 53.2% remained in sinus rhythm (group I) and the rest recurred to AF (group II). Group I had fewer atrial premature complexes per hour (APC/h) (P = 0.002) and lower maximum (max HR), average, and minimum heart rates compared with group II (all Ps < 0.05). The optimal value of APC/h and max HR with best sensitivity and specificity was 32 APC/h and 90 bpm, respectively. These findings were the predictors of AF recurrence [hazard ratio (HR) = 4.5 with 95% CI = 1.7-11.7 and HR = 4.3 with 95% CI = 1.7-10.9, respectively]. Patients with the combination of both predictors had greater HR of AF recurrence compared with those with < 32 APC/h and max HR < 90 bpm (HR = 8.8 with 95% CI = 2.5-31.4).


CONCLUSIONS
Patients with frequent APC/h and high max HR are at high risk for 1-month AF recurrence after electrical CV.
Varounis
Christos
C
1st Department of Cardiology, Onassis Cardiac Surgery Center, Syngrou Avenue 356, Kallithea 17674, Athens, Greece. varounis@hotmail.com
Dagres
Nikolaos
N
Maounis
Themistoclis
T
Panagiotakos
Demosthenes
D
Cokkinos
Dennis V
DV
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000517:prevention & control*; D018880:Atrial Premature Complexes / Q000175:diagnosis* / Q000517:prevention & control*; D018572:Disease-Free Survival; D004554:Electric Countershock; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D055502:Secondary Prevention; D012680:Sensitivity and Specificity; D016896:Treatment Outcome