title: P-wave abnormality predicts recurrence of atrial fibrillation after electrical cardioversion: a prospective study.
abstract: BACKGROUND
  Maintenance of atrial fibrillation (AF) is related to atrial electrical inhomogeneity and resultant chaotic reentry. Our aim was to test the hypothesis that abnormalities of P morphology on the surface electrocardiogram (ECG) predict recurrent AF following electrical cardioversion (ECV).
  
  
  METHODS
  A 12-lead ECG was recorded after ECV for persistent AF in 77 patients (51 men, 65 ± 10 years) and repeated 1 month later. P-wave duration was obtained in each lead using blinded on-screen measurement. Maximum P-wave duration (P-max) was defined as the longest measurable P-wave duration in any lead. P-wave dispersion (PWd) was calculated as the maximum-minimum P-wave duration.
  
  
  RESULTS
  One month after ECV, 29 (38%) patients maintained sinus rhythm. Compared with the sinus rhythm group, those with recurrent AF had significantly greater PWd (66 ± 19 vs 57 ± 16 ms, P = 0.024) and included more patients with P-max ≥142 ms (65% vs 38%, P = 0.023). Using a cutoff of ≥62 ms for PWd and ≥142 ms for P-max, both indices had similar predictive value (sensitivity 66.7 and 64.6%, specificity 58.6 and 62.1%, respectively). In multiple regression analysis, including established clinical predictors, P-max ≥142 ms was the only independent predictor of AF recurrence (P = 0.025).
  
  
  CONCLUSIONS
  A prolonged P-wave duration measured by 12-lead ECG predicts recurrent AF within 1 month after ECV.
authors: Division of Cardiac and Vascular Sciences, St. George's University of London, London, United Kingdom.
authors: Hanney
authors: H
authors: Gonna
authors: Mark Michael
authors: MM
authors: Gallagher
authors: Xiao Hua
authors: XH
authors: Guo
authors: Yee Guan
authors: YG
authors: Yap
authors: Katerina
authors: K
authors: Hnatkova
authors: A John
authors: AJ
authors: Camm
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: P wave; atrial fibrillation; electrical cardioversion; electrical dispersion; recurrence of atrial fibrillation; surface ECG