SPC365

Electrical cardioversion and atrial fibrillation recurrence: the prognostic value of P wave analysis

Session: Sessão de Posters 31 - Fibrilhação auricular: dos mecanismos ao tratamento
Speaker: João Gouveia Fiuza

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 05. Atrial Fibrillation
Subtheme: 05.8 Atrial Fibrillation - Clinical
Session Type: Cartazes
FP Number: ---
Authors: João Gouveia Fiuza; Vanda Devesa Neto; Gonçalo RM Ferreira; Mariana Duarte Almeida; Nuno Craveiro; Júlio Gil Pereira; António Costa
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Introduction:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black"> Atrial fibrillation (AF) is the most common sustained cardiac arrythmia encountered in clinical practice. Rhythm control strategy is associated with quality-of-life improvement and symptom control. Electrical cardioversion is a widely used strategy for restoring sinus rhythm. However, recurrence post-electrical cardioversion remains a significant challenge. Understanding factors influencing AF recurrence is crucial for improving management strategies.</span></span></span> </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Purpose:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black"> To evaluate the correlation between P wave characteristics on 12-lead-electrocardiogram (ECG) following elective external electrical cardioversion (ECV) and the recurrence of AF within 6 months (6M) and 12 months (12M).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Retrospective study of 49 patients admitted for elective ECV in AF patients. Baseline characteristics, echocardiographic parameters, medication history and key ECG parameters (heart rate, PR interval, maximum and minimum P wave duration, P wave dispersion, and P wave morphology) were analyzed after successful ECV. Chi-square and Mann-Whitney U were used for comparison between groups. Discrimination for AF recurrence at 12 months was assessed with the ROC curve.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Results:</span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black"> Mean age was 62&plusmn;8 years; 67,3% were men. Mean left ventricle ejection fraction was 53&plusmn;13%. Seven patients had severe left atrium dilatation (14,3%). At 6 months 11 patients (22,4%) had AF recurrence and at 12 months 30 patients (61,2%) had AF recurrence.&nbsp;</span></span></span></span></span><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">At 12M, greater P wave maximum duration (135&plusmn;23ms vs 106&plusmn;28ms, p&lt;0.01), greater PR interval (197&plusmn;45ms vs 167&plusmn;22ms, p&lt;0,.01) and greater P wave dispersion (61&plusmn;21ms vs 36&plusmn;20ms, p&lt;0.01) were associated with AF recurrence. At 6M PR interval duration (205&plusmn;38ms vs 180&plusmn;39ms, p=0.02) and P wave dispersion (64&plusmn;23ms vs 47&plusmn;23ms, p=0.04). When comparing P wave dispersion, P wave maximum duration and PR interval they were statistically significative and similar in predicting recurrence of AF at 12M (AUC 0.81, p&lt;0.01; AUC 0.778, p&lt;0.01; AUC 0.732, p&lt;0.01, respectively).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">Conclusion: </span></span></span></strong><span style="font-size:10.5pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:black">P wave characteristics, especially dispersion and maximum duration, are a readily available way to predict AF recurrence after successful ECV. Evaluation of these simple noninvasive ECG markers for atrial remodeling could assist in identifying vulnerable patients at a heightened risk and would enable the customization of management strategies based on individual patient profiles.</span></span></span></span></span></p>