title: Usefulness of P-wave signal averaging to predict atrial fibrillation recurrences after electrical cardioversion.
abstract: BACKGROUND
  Accurate markers of atrial fibrillation (AF) recurrences after electrical cardioversion (ECV) are lacking. This study was conducted to assess the value of P-wave signal averaging (SAPW) for predicting AF recurrences in a nonselected patients population submitted to ECV.
  
  
  METHODS
  A total of 133 patients (107 males, 26 females, mean age 66 ± 9 years) were included after successful ECV for persistent AF (mean duration of AF 3.6 ± 2.2 months). The mean ejection fraction (EF) was 60 ± 9%, and left atrial (LA) diameter was 44 ± 6 mm. SAPW ECG was obtained immediately after ECV and patients were prospectively followed.
  
  
  RESULTS
  During a mean follow-up of 8.9 ± 5.2 months, AF recurrences occurred in 40.6% (54/133). No SAPW parameters was statistically different between the group of patients with and the group without recurrences. Recurrences were less often observed in patients with a total P-wave duration <150 ms (16/52 or 31% vs 38/81 or 47% in patients with total P-wave duration ≥150 ms) but the difference was not statistically different (P = 0.07). P-wave duration was correlated with age (r = 0.32; P < 0.001) and left atrial diameter (r = 0.19; P = 0.02). Age, sex, structural heart disease, amiodarone therapy, or hypertension were not associated with AF recurrences but patients without recurrences had a shorter AF duration (P = 0.001) and more often had a history of previous ablation (P = 0.027).
  
  
  CONCLUSIONS
  In this unselected "real-life" group of patients submitted to ECV for persistent AF, none of the SAPW parameters, including total filtered P-wave duration, was able to predict AF recurrences.
authors.affiliation: Cardiovascular Department, Hôpital de La Tour, Meyrin-Geneva, Switzerland.
authors.forename: Coralie
authors.initials: C
authors.lastname: Blanche
authors.forename: Nam
authors.initials: N
authors.lastname: Tran
authors.forename: David
authors.initials: D
authors.lastname: Carballo
authors.forename: Fabio
authors.initials: F
authors.lastname: Rigamonti
authors.forename: Haran
authors.initials: H
authors.lastname: Burri
authors.forename: Marc
authors.initials: M
authors.lastname: Zimmermann
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D004554:Electric Countershock / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted
keywords: atrial fibrillation; recurrences; signal-averaging ECG