Refined Electrical Cardioversion Outcome Prediction with Bipolar Surface Standard Leads for Patients in Persistent Atrial Fibrillation

For persistent atrial fibrillation (AF), a low-cost, simple and effective rhythm control strategy is electrical cardioversion (ECV). This procedure presents high mid- and long-term AF recurrence rates, so anticipation of its outcome could avoid patients with high likelihood of relapsing to AF. To this end and considering the proximity of lead V1 to the right atrium, different parameters assessing fibrillatory (f-) waves reflected on this lead have been recently proposed. However, information from other leads have been mostly discarded. This study hence evaluates the effectiveness of several common parameters computed over the whole set of 12 standard ECG leads to predict ECV outcome with respect to just V1. The results for the amplitude of the f-waves, their dominant frequency and their regularity have shown better predictive abilities from limb lead II than from V1, thus providing improvements between 5 and 12% in the classification rates between patients who relapsed to AF and maintained SR during a follow-up of 4 weeks. Consequently, accessible limb lead II seems to be the best choice to anticipate ECV outcome from the ECG.