Journal Article

Atrial fibrillation signal organization predicts sinus rhythm maintenance in patients undergoing cardioversion of atrial fibrillation

Fredrik Holmqvist, Martin Stridh, Johan E.P. Waktare, Anders Roijer, Leif Sörnmo, Pyotr G. Platonov and Carl J. Meurling

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 8, issue 8, pages 559-565
Published in print August 2006 | ISSN: 1099-5129
Published online July 2006 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eul072
Atrial fibrillation signal organization predicts sinus rhythm maintenance in patients undergoing cardioversion of atrial fibrillation

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Aims Electrical remodelling is believed to influence the outcome following cardioversion of patients with persistent atrial fibrillation (AF). However, the results in clinical studies are conflicting. We assessed the hypothesis that non-invasively obtained atrial fibrillatory organization can be used as a predictor of sinus rhythm (SR) maintenance.

Methods and results Fifty-four patients (37 men, age 67±11) with persistent AF (median duration 3 months, 1 day to 18 months), without anti-arrhythmic drug treatment, referred for cardioversion were studied. Assessment of the atrial harmonic decay was made by time–frequency analysis of the ECG. At 1-month follow-up, 30 patients had relapsed into AF. The mean harmonic decay at inclusion of those relapsing into AF was 1.5±0.3 compared with 1.1±0.3 among those maintaining SR (P=0.0004). Using a cut-off value of harmonic decay ≤1.5 to determine suitability for cardioversion would have resulted in a clinically useful discriminator (sensitivity=92%, specificity=47%, PPV=59%, and NPV=88%).

Conclusion This study shows that patients relapsing rapidly to AF have a higher harmonic decay than those maintaining SR. The degree of AF signal organization (harmonic decay) was a superior discriminator to other patient parameters. Further studies are needed to confirm these results and to determine the electrophysiological correlate of harmonic decay.

Keywords: Atrial fibrillation; Electrophysiology—Clinical; Electrocardiogram; Non-invasive risk assessment tests; Harmonic decay; Cardioversion

Journal Article.  3642 words.  Illustrated.

Subjects: Cardiovascular Medicine

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