Electrocardiographic markers of cardioversion success in patients with atrial fibrillation

Background: In patients with atrial fibrillation (AF) and atrial flutter (AFL), the value of the 12-lead surface electrocardiogram (ECG) in predicting direct current cardioversion (DCCV) outcomes has not been thoroughly investigated. We sought to determine whether the type of atrial arrhythmia (AF versus AFL) and the characteristics of the atrial fibrillatory waves (fine versus coarse) on the surface ECG would help predict post DCCV outcomes. Methods: A total of 76 consecutive patients undergoing elective DCCV for persistent AF or AFL at the Minneapolis Veterans Affairs Medical Center were included in this retrospective cohort study. All patients had ECGs immediately and one month after DCCV. Results: Mean age was 67 ± 8 years and 97% of the participants were male. DCCV was immediately successful in 64 (84%) patients. Of these, 35 (46%) remained in sinus rhythm at one month. DCCV was immediately successful in all patients (N = 13) with fine AF versus 34/45 of those with coarse AF (P = 0.05). Patients with fine AF were also more likely to remain in sinus rhythm at one-month follow up compared to those with coarse AF (8/13 versus 13/45; P = 0.03). Also, at one-month follow up, the patients with AFL were more likely to maintain sinus rhythm than those with AF (14/18 of AFL versus 21/58 of AF; P = 0.003). Conclusion: The characteristics of the fibrillatory waves on surface ECG should be utilized to determine the success after DCCV in patients with AF and AFL.