Antoun Ibrahim, Li Xin, Kotb Ahmed, Barker Joseph, Mavilakandy Akash, Koev Ivelin, Vali Zakariyya, Somani Riyaz, Ng G André
Department of Cardiology, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom.
Department of Engineering, University of Leicester, Glenfield Hospital, Leicester, United Kingdom.
Front Cardiovasc Med. 2024 Jul 25;11:1417029. doi: 10.3389/fcvm.2024.1417029. eCollection 2024.
Direct current cardioversion (DCCV) is used as elective and emergency rhythm control for atrial fibrillation (AF). We aimed to explore the role of P-wave parameters measured during sinus rhythm using body surface mapping (BSM) in predicting successful DCCV for persistent atrial fibrillation (persAF) at 12 months.
This case-control study included 56 males >18 years old who underwent DCCV for persAF. P-wave parameter collection after DCCV for AF was done using 128 unipolar leads. A band-pass filter of 1-50 Hz was utilised. Corrected P-wave duration (PWDc), P-wave amplitude, and P-wave dispersion were measured to predict 12-month outcomes and time of recurrence.
The mean age was 64 ± 4 years, and 23 patients (44%) were on amiodarone. The 12-month success rate was 44% ( = 23), while the rest reverted to AF after 2.6 ± 0.4 months. The parameters were comparable between successful and failed DCCV in the entire cohort and patients not on amiodarone. In patients on amiodarone, patients with failed arms had higher PWDc than those with successful arms (188 vs. 150 ms, = 0.04). Receiver operator characteristic curve analysis for PWDc in the amiodarone cohort showed an area under the curve (AUC) of 0.75 and = 0.049. A recurrence cut-off >161 ms had a sensitivity of 69% and a specificity of 100%, with a hazard ratio of 10.7, = 0.004. The parameters were not predictive of the time of recurrence.
In patients on amiodarone, increased PWDc measured using BSM was associated with higher AF recurrence at 12 months following DCCV for persAF.
直流电复律（DCCV）用于心房颤动（AF）的择期和急诊节律控制。我们旨在探讨使用体表标测（BSM）在窦性心律期间测量的P波参数对持续性心房颤动（persAF）患者12个月时直流电复律成功的预测作用。
本病例对照研究纳入了56名年龄大于18岁、因persAF接受DCCV治疗的男性患者。AF直流电复律后使用128个单极导联收集P波参数。采用1-50Hz的带通滤波器。测量校正后的P波时限（PWDc）、P波振幅和P波离散度，以预测12个月的转归和复发时间。
平均年龄为64±4岁，23例患者（44%）服用胺碘酮。12个月成功率为44%（n=23）其余患者在2.6±0.4个月后复发为AF。在整个队列以及未服用胺碘酮的患者中，直流电复律成功组和失败组的参数具有可比性。在服用胺碘酮的患者中，治疗失败组患者的PWDc高于治疗成功组（188 vs. 150ms，P=0.04）。胺碘酮队列中PWDc的受试者工作特征曲线分析显示曲线下面积（AUC）为0.75，P=0.049。复发临界值>161ms时，敏感性为69%，特异性为100%，风险比为10.7，P=0.004。这些参数不能预测复发时间。
在服用胺碘酮的患者中，使用BSM测量的PWDc升高与persAF患者DCCV后12个月时较高的AF复发率相关。
