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Europace Advance Access published online on May 16, 2007
Europace, doi:10.1093/europace/eum090
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Atrial premature complexes and heart rate have prognostic significance in 1-month atrial fibrillation recurrence after electrical cardioversion

Christos Varounis*, Nikolaos Dagres, Themistoclis Maounis, Demosthenes Panagiotakos and Dennis V. Cokkinos

1st Department of Cardiology, Onassis Cardiac Surgery Center, Syngrou Avenue 356, Kallithea 17674, Athens, Greece

Aims The aim of this study was to investigate the significance of simple 24-h Holter (24H) data after electrical cardioversion (CV) for atrial fibrillation (AF) recurrence.

Methods We prospectively studied 47 consecutive patients subjected to CV, who successfully converted to sinus rhythm. All underwent echocardiography and 24H after CV. AF recurrence was studied at 14 days and 1 month by second 24H or by interim report of AF.

Results About 53.2% remained in sinus rhythm (group I) and the rest recurred to AF (group II). Group I had fewer atrial premature complexes per hour (APC/h) (P = 0.002) and lower maximum (max HR), average, and minimum heart rates compared with group II (all Ps < 0.05). The optimal value of APC/h and max HR with best sensitivity and specificity was 32 APC/h and 90 bpm, respectively. These findings were the predictors of AF recurrence [hazard ratio (HR) = 4.5 with 95% CI = 1.7–11.7 and HR = 4.3 with 95% CI = 1.7–10.9, respectively]. Patients with the combination of both predictors had greater HR of AF recurrence compared with those with <32 APC/h and max HR <90 bpm (HR = 8.8 with 95% CI = 2.5–31.4).

Conclusion Patients with frequent APC/h and high max HR are at high risk for 1-month AF recurrence after electrical CV.

Key Words: Atrial fibrillation, Cardioversion, Atrial premature complexes, Heart rate

* Corresponding author: Ag. Marinis 4, Egaleo 12351, Athens, Greece. Tel: +30 210 949 3341; fax: +30 210 949 3331. E-mail address: varounis{at}hotmail.com

Manuscript submitted 29 November 2006. Accepted after revision 10 April 2007.


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