Ventricular pauses during atrial fibrillation predict relapse after electrical cardioversion: a prospective study.

Aims: To investigate the use of ambulatory electrocardiogram (ECG) monitoring in atrial fibrillation (AF) to predict recurrence after electrical cardioversion (ECV). Methods: RR interval variables were obtained from 24 hours ECGs recorded before ECV in 119 patients (85 men, age 66 ± 10 years) with persistent AF. Patients were followed for 1 month. Results: Of the 119 patients, 16 (13%) failed ECV and 65 (55%) were in AF at 1 week and 81 (68%) at 1 month after ECV. The maximum RR interval (RR-max) and the minimum RR interval (RR-min) during AF were found to be reproducible. The RR-max was longer in those who had AF 1 week (2.55 ± 0.49 vs 2.01 ± 0.52 seconds, P = 0.005) and 1 month (2.56 ± 0.50 vs 1.89 ± 0.43 ms; P < 0.001) after ECV than in those who maintained sinus rhythm. Those in AF at 1 month included more patients with RR-max ≥ 2.8 seconds (31% vs 11% P = 0.021). The average heart rate was lower in patients with RR-max ≥ 2.8 seconds, but the average rate was not predictive of AF recurrence. Conclusion: Ventricular pauses during AF predict relapse after ECV. (PACE 2010; 934–938)