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Prognostic Significance of Serial P Wave Signal‐Averaged Electrocardiograms Following External Electrical Cardioversion for Persistent Atrial Fibrillation: A Prospective Study
Author(s) -
GUO XIAO HUA,
GALLAGHER MARK MICHAEL,
POLONIECKI JAN,
YI GANG,
CAMM A. JOHN
Publication year - 2003
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2003.00037.x
Subject(s) - medicine , atrial fibrillation , sinus rhythm , cardiology , cardioversion , electrocardiography , prospective cohort study , root mean square , electrical cardioversion , electrical engineering , engineering
GUO, X.H., et al. : Prognostic Significance of Serial P Wave Signal‐Averaged Electrocardiograms Following External Electrical Cardioversion for Persistent Atrial Fibrillation: A Prospective Study.The authors hypothesized that the persistence of abnormal atrial conduction detected by serial P wave signal‐averaged electrocardiograms (P‐SAECGs) can identify patients who are at high risk of recurrent atrial fibrillation (R‐AF) following electrical cardioversion (ECV). P‐SAECGs were recorded in 60 consecutive patients after ECV (53 men, age 66 ± 10 years) and repeated in those who had remained in sinus rhythm (SR) 1 week, and 1, 3, and 6 months later. Filtered P wave duration (PD), root mean square (RMS) voltage of the terminal 40, 30, 20 ms (RMS‐40, RMS‐30, RMS‐20) of the filtered P wave, RMS voltage of the entire filtered P wave (RMS‐p), and the integral of the voltages in the entire P wave (integral‐p) were analyzed. Thirty‐one (52%) patients returned to AF within 1 week, an additional 11 (18%) by 1 month, and a further 2 (3.3%) at each subsequent assessment (3 and 6 months). The patients with R‐AF had longer PD(157 ± 24 vs 143 ± 17 ms, P < 0.0001)and lower RMS‐40, RMS‐30, RMS‐20 (5.3 ± 2.0vs6.1 ± 3.4 μV, P = 0.007; 4.3 ± 1.5vs5.7 ± 3.2 μV, P < 0.0001; 3.6 ± 1.4vs5.2 ± 3.0 μV, P < 0.0001, respectively) than those who remained in SR. These measurements did not change significantly in either group. RMS‐p increased in SR patients(P = 0.009)but decreased in those who subsequently reverted to AF(P = 0.032)with a significant difference between the slopes of the RMS‐p change(P = 0.006). Integral‐p decreased from the time of ECV in the R‐AF group only(P = 0.0028)and created a significant difference between the two slopes(P = 0.0004). The evolution of P‐SAECG parameters after ECV differs in patients whose AF recurs versus patients who remain in SR. (PACE 2003; 26[Pt. II]:299–304)