Predicting Recurrence of Atrial Fibrillation in Patients Converted to Sinus Rhythm by Electrical Cardioversion Using Surface ECG: Analysis of Dispersion of P Wave Duration in Standard and Right Precordial ECG Leads

We investigated the role of P-wave dispersion in predicting recurrence of atrial fibrillation (AF) in patients converted to sinus rhythm by electrical cardioversion. Twenty patients with AF, mean age of 49 ± 1 (SE) years ( 12 females), who were converted to sinus rhythm by cardioversion, but during their six months follow-up period recurrence of AF was observed were taken into group A. Twenty patients ( 13 females) with AF, with the mean age of 51 ± 2 (SE) years, who were converted to sinus rhythm by cardioversion and during their six months follow-up period sinus rhythm was maintained were taken into group B. P-wave durations were measured in each ECG recorded after cardioversion with the rate of 50 mm/sec for a ll patients. Maximum P-wave durations (Pmaks) and minimum P-wave durations (Pmin) were detected for every ECG recording. The P-wave dispersion in standard 12 lead ECG, Pd, was described as Pd= Pmaks - Pmin, the P-wave dispersion in additional right precordial leads (V³R- V6R ) (rPd) was described as rPd= rPmaks - rPmin for each patients. The maximum P-wave duration in all detected leads was described as Pmakstotal, and the minimum P-wave duration in all detected leads was described as Pmintotal for every patient. The difference between Pmakstotal and Pmintotal was defined as largest P-wave dispersion (?p). Pmakstotal and rPmax values were higher in group A than group B (125,3 ± 0,7 (SE) msec versus 121,8 ± 0,6 msec, and 123,8 ± 0,7 msec versus 121,0 ± 0,6 msec p<0.01, p<0.01, respectively). Pmin values were higher in group B (109,1 ± 1,0 msec versus 111,6 ± 0,5 msec, respectively, p<0.05). Pd and rPd values were higher in group A(14,0 ± 1,3 msc versus 9,7 ± 0,9 msc, and 13,3 ± 0,9 msc versus 10,0 ± 0,9 msc p<0.05, p<0.05, respectively). The main difference between two group was in oup was in ?p values ( 17,1 ± 1,0 msc in group A, 12,0 ± 0,8 msc in group B, p<0.001). In conclusion, P-wave analysis and P-wave dispersion can be used in predicting of recurrence of AF in patients converted to sinus rhythm by cardioversion, and adding right precordial leads (V³R- V6R) can be more helpful. In patients with large ?p values, the risk of recurrence of AF is higher.